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The purpose of this study was to examine the content of workout videos on TikTok. A sample of 297 TikTok workout videos was coded for demographic factors and body shape of content creators, as well as the presence of body positivity messaging, appearance-related messaging, and other relevant themes. The results suggest that TikTok workout content is often presented in a time-lapse format with little verbal instruction, which may make it difficult for viewers to perform the exercises. The majority of the videos depicted young women with athletic bodies and other characteristics associated with culturally based beauty ideals, and approximately half of the videos included non-White content creators. Approximately a quarter of the videos in the sample included objectification and a smaller proportion of the sample included messages about inner positivity. Overall, the TikTok platform may provide underrepresented individuals opportunities to seek out workout content from a more diverse group of instructors; however, the fact that many of these videos including objectifying depictions of the content creators is concerning. Further experimental work is needed in order to more fully elucidate the effects of TikTok workout videos on viewers.

Given the popularity of home workouts and effects of exposure to media messaging regarding appearance ideals, the purpose of this analysis was to examine the content of YouTube home workout videos. A sample of 298 YouTube home workout videos was coded for demographic factors and body shape of instructors and the presence of body positivity messaging, appearance-related messaging, and other relevant themes. All videos in the sample included detailed instructions and demonstrations of the exercises by instructors. The majority of the videos depicted young White women with low body fat and thin/athletic bodies with visible muscles. Instructors often focused on burning fat/calories but also emphasized body functionality, exercising for fun/enjoyment, and the importance of taking care of one's body. Overall, findings demonstrate that workout instructors on YouTube conformed to unrealistic, narrowly defined appearance ideals present in Western culture, but the messaging in the videos contained many positive and affirming qualities., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This analysis examined the content of 342 body positive videos on TikTok. Videos were gathered by searching #body positivity and coded for diversity, positive body image messages, negative appearance-focused messages, other relevant themes, and contradictory messaging. Results demonstrate that body positivity videos on TikTok often portrayed young, White women with unrealistic beauty ideals. Approximately 93% of the videos embodied Western culturally based beauty ideals somewhat or to a great extent, while 32% of the videos portrayed larger bodies. Only 32.2% of the videos contained explicit positive body image messaging, and negative appearance-focused themes or objectifying content was rare. Contradictory messaging was not present. Overall, body positive videos on TikTok rarely displayed features aligned with positive body image and promoted unrealistic beauty ideals but also rarely included explicit negative appearance-focused messaging. Future research examining effects of exposure to body positivity messaging on TikTok, in comparison to other social media platforms, is warranted., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Squamoid eccrine ductal carcinoma (SEDC) is a rare cutaneous neoplasm that often manifests as a plaque or nodule in sun-exposed areas of older patients. Herein, the authors report the first case of SEDC in the eyelid. A 76-year-old man presented with a 2.5 × 1.5 mm area of left upper eyelid erythema, thickening, ulceration, and scaling with madarosis superotemporally just above the lash line. Full-thickness wedge biopsy demonstrated irregular epithelial tubules with nuclear atypia and focal squamous differentiation, consistent with SEDC. The patient underwent Mohs resection and has had no recurrence approximately 27 months after surgical removal. The authors present this case to raise awareness of SEDC to ophthalmologists as all previous cases have been described in the nonophthalmic literature. A full-thickness biopsy is recommended to avoid misdiagnosing SEDC as squamous cell carcinoma (SCC), a less aggressive tumor. With greater awareness, there may be increased recognition of this likely underreported, more malignant entity., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2022 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Abstract: Basal cell carcinoma (BCC) is the most common skin cancer, and it has numerous histologic mimics with variable prognoses and treatments. Although some immunohistochemical stains can be used for the differential diagnosis of BCC, variability and overlap in results can complicate their interpretation. Immunohistochemical staining for glioma-associated oncogene-1 (Gli-1) was performed on 26 nodular BCCs, 22 infiltrative BCCs, 9 basaloid squamous cell carcinomas, 12 desmoplastic trichoepitheliomas, 19 Merkel cell carcinomas, 11 sebaceous carcinomas, 10 cylindromas, 14 spiradenomas, 12 adenoid cystic carcinomas (AdCC), and 1 solitary trichoepithelioma. Strength of staining was scored as 0, 1+, 2+, or 3+, and distribution of staining was categorized as diffuse, multifocal, or focal. Strong, diffuse Gli-1 expression was seen in all tumors with basal epidermal-type differentiation, including BCC, trichoepithelioma, and basaloid squamous cell carcinoma. All examples of Merkel cell carcinoma were negative for cytoplasmic expression. Seven out of 11 sebaceous carcinomas were negative for Gli-1, and the remaining 4 showed 1+ expression. Cylindroma, spiradenoma, and AdCC, each an adnexal skin tumor, showed the most variable staining, but with cylindroma and spiradenoma demonstrating comparable labeling patterns. Overall, although Gli-1 may not distinguish between basal epidermal-type tumors, it may have a role in separating that group from lesions with adnexal differentiation, particularly sebaceous carcinoma, but also cylindroma, spiradenoma, and AdCC. Any cytoplasmic staining seems to exclude the diagnosis of Merkel cell carcinoma., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Aims: Lentigo maligna (LM), the most common type of melanoma in situ, is a diagnostically challenging lesion for pathologists due to abundant background melanocytic hyperplasia in sun-damaged skin. Currently, no laboratory methods reliably distinguish benign from malignant melanocytes. However, preferentially expressed antigen in melanoma (PRAME) has shown promise in this regard, and could potentially be applied to diagnosis and margin assessment in difficult cases of LM., Methods and Results: Ninety-six cases with a diagnosis of LM (n = 77) or no residual LM (n = 19) following initial biopsy were identified and stained with an antibody directed towards PRAME. Immunohistochemistry (IHC) was scored as positive or negative, and measurement of histological margins by PRAME was performed and compared to the measurement of histological margins using conventional methods [haematoxylin and eosin (H&E) and/or sex-determining region Y-box 10 (SOX10) and/or Melan-A]. Of cases with LM, 93.5% (72 of 77) were PRAME + and 94.7% (18 of 19) of cases with no residual LM were PRAME - . Of the 35 cases with no margin involvement by PRAME or conventional assessment, 14 cases (40.0%) had no difference in measurement, 17 (48.6%) had a difference of 1 mm or less and four (11.4%) differed by between 1 and 3.5 mm. There was a high correlation between margin assessment methods (r = 0.97, P < 0.0001)., Conclusions: PRAME IHC is a sensitive (93.5%) and specific (94.7%) method for diagnosing LM on biopsy and excision, and measurement of histological margins by PRAME shows a high correlation with conventional methods for margin assessment. Furthermore, the nuclear expression of PRAME makes it a good target for use in dual-colour IHC stains., (© 2021 John Wiley & Sons Ltd.)

Epidemiological data support higher prevalence of eating disorders in midlife than previously believed. Yet, few studies have examined risk factors unique to adult development. The present study examined how changes in life roles (educational, marital, and parental status) predicted disordered eating as participants transitioned from their 20s to their 50s. Participants (N = 624 women and N = 276 men) completed baseline assessments in college and at 10-, 20-, and 30-year follow-up, with 72% of women and 67% of men completing 30-year follow-up. Multilevel models examined how changes in life roles predicted changes in disordered eating. For women, obtaining a graduate degree predicted decreased eating pathology initially but over time predicted subsequent increases in Drive for Thinness. Men's eating pathology was not affected by obtaining a graduate degree. Changes in marital status demonstrated no significant association with disordered eating for either gender. Becoming a parent predicted a significant decrease in Drive for Thinness at the subsequent assessment but no further declines with age, whereas those who never had children showed significant decreases in both Drive for Thinness and Bulimia with age. For both women and men, becoming a parent may decrease the importance of shape and weight as sources of self-evaluation. However, women obtaining advanced degrees and parents may experience shifts in eating pathology related to the "Career-and-Care-Crunch" according to Mehta and colleagues' (2020) recent conceptualization of adult developmental stages. Pending independent replication, future research might design interventions for those whose role transitions put them at greater risk for disordered eating during midlife. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The Eating Disorder Inventory provides a theoretically informed multidimensional assessment of eating disorder symptoms and associated psychological factors widely used to examine the development and maintenance of eating disorders. Yet, mixed findings for some factors raise questions about whether their prognostic value varies as a function of duration of follow-up or type of eating pathology studied., Method: The current study compared prognostic value of perfectionism, maturity fears, and interpersonal distrust as predictors of restrictive versus bulimic symptom patterns at 10-, 20-, and 30-year follow-up in N = 127 individuals diagnosed with eating disorders at baseline. Multivariable regression analyses and statistical comparison of effect sizes were used., Results: Drive for Thinness at 10- and 30-year follow-up was predicted by higher Perfectionism and higher Maturity Fears at baseline. Baseline Maturity Fears also predicted higher Drive for Thinness at 20-year follow-up and higher Bulimia at 10- and 20-year follow-up. Interpersonal Distrust did not demonstrate prognostic significance in multivariable models. Comparisons of effect sizes support that some differences in statistical significance reflect differences in prognostic value of psychological factors., Discussion: Both duration of follow-up and type of pathology impact the predictive value of psychological factors and have important implications for understanding illness maintenance. Findings support the utility of targeting Perfectionism for restrictive symptoms. Developing interventions focused on Maturity Fears may provide a novel approach to reducing both restrictive and bulimic symptoms., (© 2020 Wiley Periodicals LLC.)

In the last 30 years, there has been a strong interest in vascular proliferations. Pyogenic granuloma was not only renamed lobular capillary hemangioma, but also the conceptual interpretation was also changed from an overgrowth of granulation tissue to a genuine hemangioma (or benign vascular neoplasm). We describe 19 cases of patients who presented clinically with a vascular lesion, characteristically a pyogenic granuloma or lobular hemangioma, where the histopathological findings led to the pathologic concern for a lymphoma of the skin. These benign lesions with a dense lymphoid infiltrate were further defined on the basis of different vascular and lymphoid immunohistochemical markers as inflammatory lobular hemangiomas. We propose that given the considerable histopathological overlap between acral pseudolymphomatous angiokeratoma, T-cell rich angiomatoid polypoid pseudolymphoma of the skin, and other designations of some of these vascular proliferations with a rich and dense lymphoid infiltrate, they might constitute a spectrum of vascular lesions with varying clinical presentations., (© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.)

As the literature on the narrowly defined standards of beauty portrayed in social media has increased, a newer focus on body positivity messages has also emerged. Body positivity challenges the unrealistic standards of beauty present in the media by the promotion and acceptance of diverse body sizes and appearances. In an effort to further understand the messages of body positivity in social media, this study examined the content of 246 body positive posts from the broad Instagram community. Results demonstrated an inclusion and appreciation of diverse physical appearances, as well as themes consistent with messages promoting body positivity. In contrast to content on popular body positivity accounts, several of the posts from the broader Instagram community did, however, contain contradictory messages, such as the promotion of weight loss or the praise of extreme thinness. Future research examining such contradictory messages in body positivity posts and their effects on body image and other related domains is warranted., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: Social media use has been implicated as a correlate and a cause of increased disordered eating (DE), but little is known about the impact of specific aspects of social media use, such as posting edited photos of the self. Utilizing a two-stage design, the present study sought to determine how posting edited photos relates to DE, as well as anxiety and depression symptoms, in male and female college students., Method: Stage 1 examined concurrent associations between posting edited photos and mental health measures in 2,485 undergraduates (76% female). Stage 2 examined causal associations between posting edited photos and eating disorder (ED) risk factors in 80 undergraduates (93% female) who endorsed posting edited photos in Stage 1 and volunteered for the experimental portion of the study., Results: In Stage 1, those who endorsed posting edited photos (n = 660; 27%) reported greater eating pathology and anxiety than those who did not, but no differences were found for depressive symptoms. In Stage 2, posting edited photos caused increased weight/shape concerns. Posting photos reinforced urges to exercise and restrict food intake and anxiety. Editing photos without posting caused an immediate decrease in weight/shape concerns and a delayed decrease in sadness., Discussion: Results support a consistent and direct link between posting edited photos and ED risk factors, suggesting that this is not a harmless behavior. Future work should explore the cumulative effects of this link to determine how specific uses of social media contribute to clinically meaningful outcomes., (© 2020 Wiley Periodicals, Inc.)

While our understanding of the biology of CD30 in lymphoma continues to evolve, our need to detect and measure its expression at the protein level remains critically important for diagnosis and patient care. In addition to its diagnostic and prognostic utility, CD30 has emerged as a vehicle for drug targeting through the antibody-drug conjugate brentuximab-vedotin (BV). Given the numerous ways that CD30 is utilized and its emergence as a predictive/prognostic biomarker, pathologists must come to a general consensus on the best reporting structure and methodology to ensure appropriate patient care. In this manuscript, we review the indications for testing, various modalities for testing, technical challenges, pitfalls, and potential standards of reporting. The following questions will try to be addressed in the current review article: What defines a "POSITIVE" level of CD30 expression?; How do we evaluate and report CD30 expression?; What are the caveats in the evaluation of CD30 expression?

Erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) comprise a family of mucocutaneous diseases associated with significant morbidity and mortality. Previous studies have confirmed the presence of autoantibodies to desmoplakin (Dp) I and II in patients with EM, SJS, and TEN. Truncated Dp production leads to characteristic changes visible on light microscopy: perinuclear clumping of keratin filaments and dyskeratotic keratinocyte. Based on these observations, the question arises as to whether a loss of Dp immunoreactivity in skin biopsies could serve as a diagnostic marker of EM, SJS, and TEN. This study analyzed Dp immunostaining patterns in 20 patients with EM or SJS/TEN. To assess the specificity of this approach, Dp immunostaining was also performed on specimens from patients with 5 potential histologic mimics of EM, SJS, and TEN. All of the samples from patients with EM, SJS, and TEN demonstrated absent or markedly diminished staining for Dp. A χ test demonstrated a statistically significant difference between the staining patterns in EM, SJS, and TEN and each of the other diagnostic groups that were investigated. This is the first report demonstrating statistically significant specificity of Dp staining patterns in EM/SJS/TEN as compared with other interface dermatitides.

"Personalized medicine" has been proposed as a new paradigm for patient care that, based on the integration of genomics and other "omics" data with clinical and other multidisciplinary information, promises early disease detection, improved outcomes and reduced side effects to therapies. Pathologists have become important participants in this new approach as the guardians of tissues and experts in the performance of molecular and other laboratory tests. Large amounts of new laboratory data in multiple neoplasms and other entities are being reported but there has been limited discussion about how best to evaluate the clinical significance of this information and how to integrate it into currently available diagnostic and therapeutic modalities. This article introduces a variety of epistemological problems presented by the "personalized medicine" paradigm and briefly discusses various topics that will be evaluated in further detail in future articles of this new series on Evidence-Based Pathology., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Accuracy in morphological diagnosis is the cornerstone of anatomic pathology. Proficiency with the microscope offers values to the health care system that cannot be overestimated. However, that skill is only possible if high-quality histological substrates are available for assessment, particularly focusing on hematoxylin and eosin (H&E)-stained slides. This brief review considers the several steps that are necessary to control in the preparation of high-quality H&E sections, including those dealing with fixation, embedding, microtomy, histochemical staining, and coverslipping. A table for the troubleshooting of problem slides is also included., (Copyright © 2019 Elsevier Inc. All rights reserved.)

This review describes the latest advances in the diagnosis of cutaneous T-cell lymphoma focusing on the most clinically useful features introduced since the publication of the World Health Organization revision in 2017. Clinical entities described include mycosis fungoides, Sézary syndrome, lymphomatoid papulosis, primary cutaneous anaplastic large cell lymphoma, primary cutaneous gamma delta T-cell lymphoma, primary cutaneous acral CD8 + T-cell lymphoma, primary cutaneous CD4 + small/medium T-cell lymphoproliferative disorder, and hydroa-vacciniforme-like lymphoproliferative disorder. Distinguishing histologic clues to diagnosis are discussed, and important molecular advances are described. Key prognostic indicators that may assist clinicians with timely and appropriate management options are presented., (Copyright © 2019 Elsevier Inc. All rights reserved.)

A variety of cutaneous abnormalities can be seen in patients with malignant diseases, some of which are infectious, with others representing direct involvement of the skin by the underlying disorder. Yet another group of lesions can be regarded as associated markers of the malignant process, and, as such, are termed "paraneoplastic." This review considers the latter collection of conditions, grouping them by the generic type of malignancy that is usually linked to the paraneoplasia. Some of the processes show a predominant association with alimentary tract malignancies (acanthosis nigricans, acrodermatitis paraneoplastica, florid cutaneous papillomatosis, necrolytic migratory erythema, palmoplantar keratoderma, pancreatic fat necrosis, and pityriasis rotunda). Others are usually linked to a hematolymphoid malignancy (acquired ichthyosis, exfoliative erythroderma, necrobiotic xanthogranuloma, pemphigus paraneoplastica, plane xanthoma, pyoderma gangrenosum, scleromyxedema, Sweet syndrome, and leukocytoclastic vasculitis). Finally, yet another collection of paraneoplastic skin disorders can associate themselves with anatomically-diverse malignancies (Leser-Trelat syndrome, Trousseau syndrome, dermatomyositis, erythema gyratum repens, hypertrichosis lanuginosa acquisita, papuloerythroderma of Ofuji, tripe palms, and multicentric reticulohistiocytosis). Recognition of these processes by the pathologist can be a valuable step in the characterization of underlying malignant diseases., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Basaloid tumors of the skin pose a diagnostic challenge to pathologists, because the differential diagnosis is broad, sometimes with subtle differentiating features. We evaluated SOX10 expression in 120 primary cutaneous tumors with epidermal, sweat glandular, neuroendocrine/neuroectodermal, follicular, and sebaceous lineages. Our findings were compared with those of previous studies that evaluated SOX10 in tumors of the skin. SOX10 staining was seen in the majority of sweat gland tumors with the exception of syringoma and microcystic adnexal carcinoma. There were no immunoreactive cases among epidermal, neuroendocrine/neuroectodermal, follicular, or sebaceous tumors. These findings are comparable to reported in previous studies, and show SOX10 can be a useful adjunct in the differential diagnosis of nodular basaloid skin tumors. That marker has less utility in the assessment of sclerosing basaloid cutaneous neoplasms, because such tumors are almost uniformly nonreactive for it.

Tumor-like malformative lesions are seen throughout the body, and they may be confused with true neoplasms by clinicians and pathologists alike. In the lungs, they are principally represented by hamartomas-which may contain chondroid, adipocytic, fibroblastic, and myxoid tissue, with entrapped bronchiolar epithelium-and congenital pulmonary airway malformations (CPAMs). The latter have been subdivided into 5 groups, based on their histological features, but they basically comprise proliferations of malformed bronchopulmonary tissues of different types. Type 1 lesions have a capacity for malignant transformation in a small proportion of cases. Malformative cardiac tumefactions include rhabdomyoma-like hamartomas; fibromatous hamartomas; and mesenchymal ventricular hamartomas, which contain cardiac muscle, smooth muscle, fat, vasogenic tissue, and nerves. Another intracardiac proliferation in the same general category is seen in the interatrial septum, in the region of the atrioventricular node. It comprises randomly-disposed gland-like profiles that are made up of endodermal epithelium. Originally thought to be a form of mesothelial lesion, that abnormality is now classified as an endodermal choristoma. All forms of pulmonary and cardiac malformations are only rarely symptomatic, and the necessity for surgical excision of them depends on the particular details of each case., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Non-neoplastic skin lesions comprise a sizable group of disorders with variable etiologies and clinical manifestations. They can be grouped into vesiculopustular dermatitides; spongiotic and psoriasiform diseases; lichenoid dermatitides; lymphoid infiltrates of the dermis; granulomatous processes; bullous disorders; vasculopathies; panniculitides; deposition disorders; and defects in maintenance of dermal connective tissue. The use of histochemical methods continues to be an indispensable adjunct to conventional microscopy in the further characterization of such lesions. This review considers that topic., (Copyright © 2018. Published by Elsevier Inc.)

Histochemistry has a history which, in some ways, goes back to ancient times. The desire for humans to understand the workings of their bodies, and the roles that various chemicals have in them, is long-standing. This review considers the evolution of histochemistry and cytochemistry as scientific disciplines, culminating in the pairing of those techniques with basic biochemistry. They have served as the bases for a synthesis of microscopy, chemistry, immunology, and molecular biology, particularly in the practice of anatomic pathology., (Copyright © 2018. Published by Elsevier Inc.)

Indeterminate dendritic cell tumor (IDCT) is a cutaneous proliferation of histiocytes that share morphologic and immunophenotypic properties with Langerhans cells. IDCT was recently included in the updated WHO classification of tumors of hematopoietic and lymphoid tissues. Recent studies have shown that some cases of IDCT demonstrate an ETV3-NCOA2 translocation, supporting the idea that IDCT is a clonal neoplasm. We report 2 new cases of IDCT at our institution lacking the ETV3-NCOA2 translocation. We also present a comprehensive review of reported cases of IDCT in the medical literature. Eighty-five cases of IDCT were reported in the literature between 1985 and 2016. The median age at diagnosis was 45 years. In contrast to Langerhans cell histiocytosis, IDCT is limited to the skin in the majority of cases (88%) and generally follows an indolent clinical course. Most reported lesions are cured with complete excision. However, the histologic features of IDCT and langerhans cell histiocytosis are similar. Conjoint immunostaining for CD1a and langerin is necessary for optimal classification.

Smoking-related interstitial fibrosis (SRIF) is frequently-seen and morphologically-distinctive finding in the lung tissue of cigarette smokers. It can be distinguished histologically from the idiopathic interstitial pneumonias and other causes of pulmonary interstitial fibrosis. SRIF is typified by dense thickening of the alveolar septa by thick collagen bundles with a hyalinized appearance, with the common admixture of bands of hyperplastic smooth muscle. Concomitant inflammation is minimal. SRIF predominates in the subpleural and centrilobular parenchyma, and is usually accompanied by the changes of centrilobular emphysema and respiratory bronchiolitis. Most patients with SRIF do not have clinical symptoms of the condition. This article reviews the pathologic features of SRIF and compares them with the appearances of other interstitial lung diseases, some of which are also related to cigarette smoking. Acute eosinophilic pneumonia is another lung disease that has an association with smoking, and its clinicopathologic features are considered here as well., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis frequently manifests with involvement of the lungs and kidneys, and it also may affect other anatomic sites. This article presents the patterns of pulmonary injury in which ANCA-associated vasculitis is included in the differential diagnosis, with a discussion of antineutrophil cytoplasmic antibody testing methods. The histologic features of non-vasculitic, potentially-ANCA-associated pulmonary lesions are reviewed briefly as well., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Sclerosing squamous cell carcinoma (SCC), also known as "desmoplastic" SCC, is a rare subtype of cutaneous malignancy. This variant is clinically significant because it is associated with an increased risk of local recurrence and metastasis. We herein present 16 examples of sclerotic SCC of the skin in 8 men and 3 women, with a median age of 66 years. The most common site of origin for this tumor is the skin of the head and neck, including the scalp (5 tumors in 2 different patients), forehead (3 cases), nasal ala (2 cases), neck (2 cases in the same patient), ear (2 cases), cheek (1 case), and chest (1 case). Microscopically, sclerosing SCCs are characterized by cellular cords, nests, and islands, as well as scattered single cells infiltrating densely desmoplastic and collagenized connective tissue. The differential diagnosis principally includes sclerosing basal cell carcinoma, microcystic adnexal carcinoma, and desmoplastic trichoepithelioma. The main goals of this study are to further characterize these lesions pathologically, and increase general awareness of this SCC subtype.

In the setting of synchronous pulmonary carcinomas, distinguishing between a monoclonal process with intrapulmonary metastasis and two independent tumors has significant therapeutic and prognostic implications. We describe two cases in which molecular profiling was used to characterize synchronous, primary pulmonary tumors and guide clinical management. In both cases, the patients underwent surgical resection without adjuvant chemotherapy or radiation and remain free of disease., (Published by Elsevier Inc.)

Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder usually presents as a slow-growing and asymptomatic solitary lesion in the form of a nodule or tumor in the head and neck region. By definition, it is histologically characterized by small- to medium-sized CD4+ lymphocytes involving the dermis in a dense and either nodular or diffuse pattern. Epidermotropism should be absent or minimal. Tumor cells are accompanied by numerous reactive B cells, plasma cells, histiocytes, and eosinophils. This lymphoproliferative disorder is characterized by the expression of follicular helper T-cell markers, particularly B-cell lymphoma 6 (BCL-6), programmed cell death protein 1 (PD-1), and C-X-C motif chemokine ligand 13 (CXCL-13), while CD10 is usually negative. Molecular studies show a clonal rearrangement of T-cell receptor genes in more than 60% of cases. Management of disease includes surgical excision, radiation therapy, and steroids (topical or intralesional). Patients with this diagnosis have an excellent prognosis, with a clinical course that is invariably indolent., (©2018 Frontline Medical Communications.)

The metastasis of neoplastic cells from their site of origin to distant anatomic locations continues to be the principal cause of death from malignant tumors, and that fact has been recognized by physicians for over a century. After the work done by Halsted in the treatment of breast cancer in the 1880s, accepted surgical canon held that metastasis occurred in a linear fashion, with centrifugal "growth in continuity" from the primary neoplasm that first involved regional lymph nodes. Those structures were considered to then be the sources of more distant, visceral metastases. With that premise in mind, radical and "ultra-radical" surgical procedures were devised to remove as many lymph nodes as possible in the treatment of carcinomas and melanomas. However, such interventions were ineffective in altering tumor-related mortality. This review considers the details of the historical material just mentioned. It also reviews currently-held concepts on biological mechanisms of metastasis, the "sentinel" lymph node biopsy technique, and the important topic of metastatic tumor "dormancy" as the cause of surgical treatment failure. Finally, predictive models of tumor behavior are discussed, which are based on gene signatures. These will likely be the key to identifying malignant lesions of low surgical stage that ultimately prove fatal through later manifestation of metastasis., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Several primary pathologic entities in diverse anatomic locations have the potential to simulate metastatic neoplasms histologically. Their misinterpretation as such may result in needless and extensive clinical evaluations that are intended to detect a presumed malignancy at another site. More importantly, mistakes of this type can deprive patients of surgical excisions that could be curative. This presentation considers a review of selected primary lesions that can simulate metastases. They include hemangioblastoma, glioblastoma and meningioma with epithelial metaplasia, choroid plexus carcinomas, primary neuroendocrine carcinomas in unusual locations, special forms of sinonasal and salivary glandular adenocarcinoma, clear-cell thyroid carcinomas, unusual microscopic subtypes of pulmonary adenocarcinoma, epithelioid myomelanocytomas ("sugar tumors"), mesotheliomas, primary thymic carcinomas, endodermal choristomas of the interatrial myocardium, peripheral cholangiocarcinoma, adrenocortical carcinoma, adenocarcinomas of the urinary bladder, mucinous and "rhabdoid" tumors of the ovaries, rete testis adenocarcinomas, interdigitating dendritic-cell sarcoma of lymph nodes, selected sweat gland carcinomas, cutaneous Merkel cell carcinoma, primary dermal and subcutaneous melanoma, mucosal and visceral melanomas, epithelioid sarcoma, clear-cell sarcoma, and adamantinoma of long bones. Differential diagnostic observations are emphasized in reference to those lesions., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Thinspiration is content advocating extreme weight loss by means of images and/or text posts. While past content analyses have examined thinspiration content on social media and other websites, no research to date has examined thinspiration content on Tumblr. Over the course of a week, 222 images and text posts were collected after entering the keyword 'thinspiration' into the Tumblr search bar. These images were then rated on a variety of characteristics. The majority of thinspiration images included a thin woman adhering to culturally based beauty, often posing in a manner that accentuated her thinness or sexuality. The most common themes for thinspiration text posts included dieting/restraint, weight loss, food guilt, and body guilt. The thinspiration content on Tumblr appears to be consistent with that on other mediums. Future research should utilize experimental methods to examine the potential effects of consuming thinspiration content on Tumblr., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Avoidant-restrictive food intake disorder (ARFID) is a current diagnosis in the "Feeding and Eating Disorders" section of the Diagnostic and Statistical Manual of Mental Disorders (fifth edition) and captures a heterogeneous presentation of eating disturbances. In recent years, ARFID has been studied primarily within the context of eating disorders despite having historical roots as a feeding disorder. The following review examines ARFID's similarities with and differences from feeding disorders and eating disorders, focusing on research published within the last three years. Implications of this differentiation for treatment are discussed., Competing Interests: No competing interests were disclosed.No competing interests were disclosed.No competing interests were disclosed.

IgG4-related sclerosing disease, which now encompasses diverse organ-related disorders with various prior eponymic designations, may also present with solitary or multifocal lymph node enlargement. This review considers the histopathologic features of IgG4 lymphadenopathy (IgG4LAD), which has been subdivided by Cheuk & Chan into 5 microscopic subtypes. Those include variants that are typified by multicentric Castleman disease (MCD)-like changes, follicular hyperplasia, interfollicular lymphoplasmacytic proliferation, progressive transformation of germinal centers, and formation of inflammatory pseudotumor (IPT)-like lesions. All of them demonstrate an excess of IgG4-immunoreactive plasma cells in the inflammatory cell population. Differential diagnostic considerations for IgG4LAD include true MCD, true IPT, luetic lymphadenitis, Rosai-Dorfman disease, and inflammatory myofibroblastic tumor, among others. An interpretative distinction between malignant lymphoma and IgG4LAD is also crucial., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Most prior studies of primary diagnosis in surgical pathology using whole slide imaging (WSI) versus microscopy have focused on specific organ systems or included relatively few cases. The objective of this study was to demonstrate that WSI is noninferior to microscopy for primary diagnosis in surgical pathology. A blinded randomized noninferiority study was conducted across the entire range of surgical pathology cases (biopsies and resections, including hematoxylin and eosin, immunohistochemistry, and special stains) from 4 institutions using the original sign-out diagnosis (baseline diagnosis) as the reference standard. Cases were scanned, converted to WSI and randomized. Sixteen pathologists interpreted cases by microscopy or WSI, followed by a wash-out period of ≥4 weeks, after which cases were read by the same observers using the other modality. Major discordances were identified by an adjudication panel, and the differences between major discordance rates for both microscopy (against the reference standard) and WSI (against the reference standard) were calculated. A total of 1992 cases were included, resulting in 15,925 reads. The major discordance rate with the reference standard diagnosis was 4.9% for WSI and 4.6% for microscopy. The difference between major discordance rates for microscopy and WSI was 0.4% (95% confidence interval, -0.30% to 1.01%). The difference in major discordance rates for WSI and microscopy was highest in endocrine pathology (1.8%), neoplastic kidney pathology (1.5%), urinary bladder pathology (1.3%), and gynecologic pathology (1.2%). Detailed analysis of these cases revealed no instances where interpretation by WSI was consistently inaccurate compared with microscopy for multiple observers. We conclude that WSI is noninferior to microscopy for primary diagnosis in surgical pathology, including biopsies and resections stained with hematoxylin and eosin, immunohistochemistry and special stains. This conclusion is valid across a wide variety of organ systems and specimen types.

Context: - Malignant mesothelioma (MM) is an uncommon tumor that can be difficult to diagnose., Objective: - To provide updated, practical guidelines for the pathologic diagnosis of MM., Data Sources: - Pathologists involved in the International Mesothelioma Interest Group and others with an interest and expertise in the field contributed to this update. Reference material included up-to-date, peer-reviewed publications and textbooks., Conclusions: - There was discussion and consensus opinion regarding guidelines for (1) distinguishing benign from malignant mesothelial proliferations (both epithelioid and spindle cell lesions), (2) cytologic diagnosis of MM, (3) recognition of the key histologic features of pleural and peritoneal MM, (4) use of histochemical and immunohistochemical stains in the diagnosis and differential diagnosis of MM, (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas, and squamous cell and renal cell carcinomas), (6) diagnosis of sarcomatoid MM, (7) use of molecular markers in the diagnosis of MM, (8) electron microscopy in the diagnosis of MM, and (9) some caveats and pitfalls in the diagnosis of MM. Immunohistochemical panels are integral to the diagnosis of MM, but the exact makeup of panels employed is dependent on the differential diagnosis and on the antibodies available in a given laboratory. Depending on the morphology, immunohistochemical panels should contain both positive and negative markers for mesothelial differentiation and for lesions considered in the differential diagnosis. Immunohistochemical markers should have either sensitivity or specificity greater than 80% for the lesions in question. Interpretation of positivity generally should take into account the localization of the stain (eg, nuclear versus cytoplasmic) and the percentage of cells staining (>10% is suggested for cytoplasmic and membranous markers). Selected molecular markers are now being used to distinguish benign from malignant mesothelial proliferations. These guidelines are meant to be a practical diagnostic reference for the pathologist; however, some new pathologic predictors of prognosis and response to therapy are also included.

The immune checkpoint inhibitors targeting cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and the programmed death protein 1 (PD-1)/PD-L1 pathway have recently shown promising therapeutic results in patients with metastatic melanoma. Dermatologic side effects of these agents occur in ∼30-40% of cases. Here, we report the development of a biclonal cutaneous T-cell lymphoproliferative disorder in a patient being treated with ipilimumab (a CTLA-4 inhibitor) for metastatic melanoma. Nivolumab (a PD-1 inhibitor) had also been administered to him previously. An 8 mm reddish papule appeared on the skin of the left forearm. A biopsy of that lesion showed an atypical population of predominantly CD4-positive, CD30-positive T-cells that also expressed PD-1 and PD-L1 immunohistochemically. PCR studies for T-cell receptor rearrangements showed the presence of two distinct clonal T-cell populations. The lesion was completely excised and the patient had no local recurrences. There was also no subsequent evidence of a systemic lymphoproliferative process. Although the development of a lymphoid skin lesion in our patient may have only been coincidentally related to his treatment, immunostimulatory drugs could theoretically cause clonal expansion of a population of lymphocytes that leads to a lymphoproliferative disorder.

Some cutaneous inflammatory disorders are typified by a predominant or exclusive localization in the dermis. They can be further subdivided by the principal cell types into lymphocytic, neutrophilic, and eosinophilic infiltrates, and mixtures of them are also seen in a proportion of cases. This review considers such conditions. Included among the lymphoid lesions are viral exanthems, pigmented purpuras, gyrate erythemas, polymorphous light eruption, lupus tumidus, and cutaneous lymphoid hyperplasia. Neutrophilic infiltrates are represented by infections, Sweet syndrome, pyoderma gangrenosum, and hidradenitis suppurativa, as well as a group of so-called "autoinflammatory" dermatitides comprising polymorphonuclear leukocytes. Eosinophil-dominated lesions include arthropod bite reactions, cutaneous parasitic infestations, the urticarial phase of bullous pemphigoid, Wells syndrome (eosinophilic cellulitis), hypereosinophilic syndrome, and Churg-Strauss disease. In other conditions, eosinophils are admixed with neutrophils in the corium, with or without small-vessel vasculitis. Exemplary disorders with those patterns include drug eruptions, chronic idiopathic urticaria, urticarial vasculitis, granuloma faciale, and Schnitzler syndrome (chronic urticarial with a monoclonal gammopathy)., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. In the non-infectious group, examples of necrobiotic or necrotizing granulomas include granuloma annulare; necrobiosis lipoidica; rheumatoid nodule; and lupus miliaris disseminates faciei. Non-necrobiotic/necrotizing and non-infectious lesions are exemplified by sarcoidosis; foreign-body reactions; Melkersson-Rosenthal syndrome; Blau syndrome; elastolytic granuloma; lichenoid and granulomatous dermatitis; interstitial granulomatous dermatitis; cutaneous involvement by Crohn disease; granulomatous rosacea; and granulomatous pigmented purpura. Histiocytic dermatitides that do not feature granuloma formation are peculiar reactions to infection, such as cutaneous malakoplakia; leishmaniasis; histoplasmosis; lepromatous leprosy; rhinoscleroma; lymphogranuloma venereum; and granuloma inguinale., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Several dermatoses are typified by the formation of spaces (blisters; bullae) within or beneath the epidermis. These may be acellular or filled with particular species of inflammatory cells. Etiological categories include infectious, immune-mediated, genetic, drug-related, and idiopathic lesions. Examples of such disorders include impetigo, Herpes virus infections, pemphigus, bullous pemphigoid and pemphigoid gestationis, epidermolysis bullosa acquisita, IgA-related dermatoses, inherited epidermolysis bullosa variants, Hailey-Hailey disease, and porphyria cutanea tarda. Other conditions manifest microscopic acantholysis within the surface epithelium but are not associated with clinical bullae, such as Darier disease and Grover disease. Finally, both infectious and non-infectious causes exist for the development of neutrophilic pustules in the epidermis, as seen in pustular psoriasis, Sneddon-Wilkinson disease (subcorneal pustular dermatosis), and acute generalized exanthematous pustulosis. This review considers the clinical and histological features of all of these diseases., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Psoriasis vulgaris (PV)-the prototypical "psoriasiform" dermatitis-may assume a spectrum of histologic appearances, depending on whether it has been treated or not. Because of that relative lack of morphological uniformity, other skin disorders that feature epidermal acanthosis, with or without associated inflammation, may be confused diagnostically with PV. This brief review considers the clinicopathologic attributes of PV and its imitators, including chronic spongiotic dermatitides, lichen simplex chronicus, prurigo nodularis, pityriasis rubra pilaris, psoriasiform secondary syphilis, and Reiter syndrome., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The diagnosis of panniculitis is felt to be a confusing topic by some pathologists. This summarical article presents inflammatory diseases of the subcutis in a systematic fashion, based on whether they are centered on fibrovascular septa or the adipose lobules, and whether morphologic vasculitis is present or not. Septocentric, non-vasculitis disorders include erythema nodosum, panniculitis that follows the use of "biological" therapeutic agents, lipodermatosclerosis, post-irradiation panniculitis, morphea profunda, and necrobiosis lipodica profunda. Polyarteritis nodosa and Behçet's disease are the conditions that are based in the subcutaneous septa with vasculitis. Predominantly-lobular panniculitides with no vasculitis include pancreatogenic panniculitis, the panniculitis of alpha-1-antitrypsin deficiency, panniculitis associated with lupus erythematosus and dermatomyositis, subcutaneous Sweet syndrome, eosinophilic panniculitis, factitial panniculitis, cold panniculitis, panniculitis following injections of corticosteroids, lipomembranous (ischemic) panniculitis; sclerema neonatorum and subcutaneous fat necrosis of the newborn, and Rosai-Dorfman disease of the subcutis. Erythema induratum and infectious panniculitis are vasculitic and lobulocentric conditions. This article reviews the histological features of these diseases., (Copyright © 2017 Elsevier Inc. All rights reserved.)