Search

* Context.--The American Society of Clinical Oncology/ College of American Pathologists updated the human epidermal growth factor receptor 2 (HER2) breast carcinoma testing guideline in 2018 to address issues from uncommon HER2 fluorescence in situ hybridization (FISH) results. Based on the 2013 American Society of Clinical Oncology/College of American Pathologists guideline, cases wherein the HER2/chromosome 17 centromere (CEP17) ratio of 2.0 or more with an average HER2 copy number of less than 4.0 were considered in situ hybridization (ISH) positive. Under the 2018 guideline, such cases are classified as ISH Group 2 and are no longer considered eligible for anti-HER2 therapy when the corresponding HER2 immunohistochemistry result is 0, 1+, or 2+. Objective.--To assess the clinical, pathologic, and treatment aspects of patients with ISH Group 2 results. Design.--We retrospectively reviewed HER2 FISH results at our center between January 2012 and December 2014 and identified and characterized cases with ISH Group 2 results. Results.--Thirty-nine cases with ISH Group 2 results from 39 patients were reviewed. Twenty of 39 (51%) patients received anti-HER2 therapy. Patients treated with HER2-targeted therapy were less likely to have hormone receptor-positive tumors, compared with patients without anti-HER2 treatment, though not significantly (P = .30). The only significant difference between the 2 patient groups was receipt of cytotoxic chemotherapy treatment (P < .001). Overall, clinical outcome was similar between the 2 groups (P > .99). Conclusions.--This retrospective study with median follow-up of at least 6 years shows patients with ISH Group 2 tumors had similar clinical outcomes, irrespective of HER2-targeted therapy. Further analysis in the prospective setting would provide valuable data that would potentially inform clinical decision making., Approximately 15% to 20% of primary invasive breast carcinomas display overexpression of receptor tyrosine kinase human epidermal growth factor receptor 2 (HER2), owing to amplification of its corresponding encoding gene [...]

This article, published in the International Journal of Surgical Pathology, presents a case study of a 53-year-old woman with a rapidly enlarging breast mass. The mass was initially diagnosed as a fibroadenoma but was later found to be a malignant phyllodes tumor (MPT) with heterologous telangiectatic osteosarcoma. MPTs are rare and aggressive tumors with a high risk of recurrence and metastasis. The presence of heterologous elements, such as osteosarcoma, classifies the tumor as MPT. This case is unusual because telangiectatic osteosarcoma arising in MPT is rare, with few reported cases in the literature. The article provides detailed histologic descriptions and diagnostic criteria for this type of tumor. The patient underwent resection and adjuvant radiation therapy and has remained disease-free for 19 months. [Extracted from the article]

Introduction: Solitary fibrous tumor (SFT) is a fibroblastic tumor with malignant potential that is underpinned by a recurrent inv12(q13q13)-derived NAB2::STAT6 fusion. Breast and axilla are uncommon locations for this entity. Methods: Records of two academic institutions were electronically searched for breast and axillary SFTs. Clinical and pathologic data were reviewed. Literature review for breast or axillary SFTs was performed. Present study and previously reported tumors were stratified using five SFT risk models: original and modified Demicco metastatic risk, Salas local recurrence risk, Salas metastatic risk, and Thompson local recurrence risk. Results: Five patients with breast or axillary SFT were identified. Median age was 49 years, and median follow-up (available for four patients) was 82 months. Three patients showed no evidence of disease, and one developed recurrence. Literature review identified 58 patients with breast or axillary SFT. Median age was 54 years, and median follow-up (available for 35 patients) was 24 months. Thirty-one patients showed no evidence of disease, three developed recurrence, and one developed metastasis. Original and modified Demicco models and Thompson model showed the highest sensitivity; original and modified Demicco models and Salas metastatic risk model demonstrated the highest specificity. Kaplan–Meier models were used to assess recurrence-free probability (RFP). Original and modified Demicco models predicted RFP when stratified by "low risk" and "moderate/intermediate and high risk" tumor, though sample size was small. Conclusions: While many SFTs of breast and axilla remain indolent, a subset may develop recurrence and rarely metastasize. The modified Demicco risk model demonstrated optimal performance characteristics. [ABSTRACT FROM AUTHOR]

Background. Classification of phyllodes tumors is challenging due unclear diagnostic criteria, recently addressed by consensus review criteria. Herein, we reviewed all malignant phyllodes tumor resections and reclassified them based on the consensus guidelines, correlating with outcome. We hypothesize that application of criteria would result in a significant proportion being "down-graded" to either borderline or benign phyllodes tumor. Methods. Primary resections of malignant phyllodes tumor were reviewed by four AP board-certified, breast fellowship-trained pathologists. Morphologic variables delineated in consensus guidelines (ie stromal cellularity, cellular atypia, tumor border, presence of heterologous elements, presence of stromal overgrowth) were evaluated. Following review, cases were reclassified as benign, borderline, or malignant. Results. Upon reclassification, 20% (5/20) cases were "down-graded" to borderline phyllodes tumor while 80% (15/20) remained malignant phyllodes tumor. Two morphologic features were statistically significant including broadly infiltrating tumor border in 80% (12/15) of malignant phyllodes tumors compared to none in borderline phyllodes tumor (0/5) (p = 0.004) and stromal overgrowth in 67% (10/15) of malignant phyllodes tumor compared to none in borderline phyllodes tumors (0/5) (p = 0.03). Upon review of the pathology reports, 30% (6/20) contained all 5 histomorphologic variables delineated in the consensus review criteria. Malignant phyllodes tumor resulted in five cases with recurrence (33.3%, 5/15) and three cases with metastases (20.0%, 3/15) and borderline phyllodes tumor resulted in one case with recurrence (20.0%, 1/5) and no metastases (0/5). Conclusion. The consensus guidelines for phyllodes tumor are useful for subclassification. We hypothesize that standardize reporting of the histomorphologic variables may lead to better consensus. [ABSTRACT FROM AUTHOR]

Urinary cytology (UC) is one of the primary diagnostic modalities used for the screening and surveillance of urothelial carcinoma. Despite its widespread use, UC has suffered from a lack of standardized or reproducible criteria and wide interobserver variability, particularly of the designation of atypical urothelial cells. The Paris System for Reporting Urinary Cytology (TPS), published in 2016, aimed to provide a standardized approach for evaluating UC by creating diagnostic categories with specific cytomorphologic criteria. Recent studies have primarily investigated the application of TPS on lower urinary tract specimens and have mostly shown that TPS implementation has improved the performance of UC specimens. Only a few studies have reported the impact of TPS on upper urinary tract (UUT) cytology. Additionally, there is uncertainty as to which cytological features are most predictive of high‐grade urothelial carcinoma (HGUC) in the UUT. This review summarizes the literature regarding the utility and performance of UUT cytology and highlights findings before and after the implementation of TPS. Recent studies have investigated the application of The Paris System for Reporting Urinary Cytology (TPS) on lower urinary tract specimens and have mostly shown that TPS implementation improves performance. This review summarizes the literature regarding the utility and performance of upper urinary tract cytology specimens and highlights findings before and after the implementation of TPS. [ABSTRACT FROM AUTHOR]

Amyloidosis is a clinical disorder in which deposition of amyloid fibrils in tissues leads to symptoms. In modern pathology laboratories, Congo red is the preferred screening method for amyloidosis; however, deficiencies of polarized light microscopy are well documented.[9] The specificity of Congo red stain for amyloid via light microscopy is operator dependent. [Extracted from the article]

Background: Urinary cytology is sensitive and specific for diagnosing and screening high‐grade urothelial carcinomas (HGUC). The Paris System (TPS) for urinary cytology was introduced in 2016 to standardize reporting. According to TPS diagnostic categories of HGUC and suspicious for HGUC (SHGUC), the average nuclear‐to‐cytoplasm (N:C) ratio of atypical cells should be ≥0.7. The objective of the current study was to measure the N:C ratio of urine cytology specimens with HGUC and SHGUC diagnoses and biopsy‐proven HGUC follow‐up. Methods: A cohort of 64 cases (HGUC, 49 cases; SHGUC, 15 cases) from 57 patients was constructed. Urine cytology slides were scanned into whole‐slide digital images. The nuclear and cytoplasmic areas were enumerated by digital image analysis (DIA), and the N:C ratios were measured. Results: In total, 640 cells were analyzed by DIA (HGUC, 490 cells; SHGUC, 150 cells). For HGUC and SHGUC, the average N:C ratios were 0.57 and 0.53, respectively. The maximum average N:C ratio was 0.73 for HGUC and 0.68 for SHGUC. HGUC had higher average N:C ratio (P <.001), higher average nuclear area (P <.001), higher average maximum N:C ratio (P =.005), and higher average maximum nuclear area (P =.006) compared with SHGUC. Conclusions: The N:C ratios for the HGUC (0.57) and SHGUC (0.53) categories are lower than those previously suggested in TPS. The authors advocate reducing the N:C ratio below the current threshold of 0.7.Digital image analysis demonstrates that the average nuclear‐to‐cytoplasmic ratio of malignant urothelial cells in urine specimens with diagnoses of high‐grade urothelial carcinoma (HGUC) and suspicious for HGUC (SHGUC) is below the 0.7 threshold set by The Paris System. The authors advocate for reducing the nuclear‐to‐cytoplasmic ratio for the HGUC and SHGUC categories in The Paris System. [ABSTRACT FROM AUTHOR]

Self-healing chemistry used for damage repair have not previously been demonstrated for free-radical polymerization pathways. However, this chemistry is important for addition polymers such as poly(methyl methacrylate) used in bone cement and epoxy vinyl ester used in dental resins. Self-healing biomaterials offer the potential for safer and longer lasting implants and restoratives by slowing or arresting crack damage. In the free-radical self-healing system reported here, the three components required for polymerization (free-radical peroxide initiator, tertiary amine activator, and vinyl acrylate monomers) are compartmentalized into two separate microcapsules-one containing the peroxide initiator, and the other containing both monomer and activator. Crack damage ruptures the capsules so that the three components mix and react to form a new polymer that effectively rebonds the crack and restores approximately 75% of the original fracture toughness. Optimal healing is obtained by a systematic evaluation of the effect of monomer, initiator, and activator concentration on healing performance. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 3024-3032, 2014. [ABSTRACT FROM AUTHOR]