Introduction to inflammatory dermatoses: histological clues for the practicing pathologist
The discipline of dermatopathology is complex and very frequently practicing surgical pathologists feel overwhelmed by the complexity of the inflammatory disorders. While the easy approach to handling those cases relies on having an ‘expert’ dermatopathology opinion, in many circumstances such cases can be managed using a descriptive approach and having an open dialogue and communication with the referring clinicians. Most frequently, dermatologists, who have a broad clinical and pathologic experience to the diagnosis and t herapy of skin diseases, can adequately orient the pathologist to the understanding and recognit...
Source: Seminars in Diagnostic Pathology - December 23, 2016 Category: Pathology Authors: Alejandro A Gru Source Type: research
Fibrolamellar carcinoma: A histologically unique tumor with unique molecular findings
Fibrolamellar carcinoma is a unique type of hepatocellular carcinoma with a distinctive predilection for young patients without underlying liver disease, characteristic large neoplastic cells with intervening, dense fibrosis, co-expression of keratin 7 and CD68 and activation of protein kinase A (most often by formation of DNAJB1-PRKACA). Fibrolamellar carcinoma has a similar prognosis to conventional hepatocellular carcinomas arising in non-cirrhotic livers. The current American Joint Cancer Committee staging system does not provide optimal stratification of patients with fibrolamellar carcinoma and an alternate systems s...
Source: Seminars in Diagnostic Pathology - December 22, 2016 Category: Pathology Authors: Rondell P. Graham, Michael S. Torbenson Source Type: research
Differential Diagnosis of Epithelioid and Clear Cell Tumors in the Liver
A tumor composed of large eosinophilic cells in the liver raises concern for hepatocellular carcinoma, which is typically composed of such cells. However, there are other tumors, both primary and metastatic, that may be composed predominantly of large epithelioid cells. Distinction of these tumors from hepatocellular carcinoma and from each other is of obvious importance for patient management. Similarly, a clear cell tumor anywhere in the body triggers suspicion for renal cell carcinoma. However, other tumors, including hepatocellular carcinoma can rarely be composed entirely of cell cells and the distinction of these fro...
Source: Seminars in Diagnostic Pathology - December 21, 2016 Category: Pathology Authors: Steven Alexander Mann, Romil Saxena Source Type: research
Hepatoblastoma
is the most common primary malignant hepatic tumor of infancy and childhood, occurring predominantly in the first two years of life. The management of hepatoblastoma has changed markedly over the last 3 decades; neoadjuvant chemotherapy is now standard, particularly in unresectable tumors resulting in considerable preoperative tumor shrinkage and sometimes near total ablation of the tumor. A 20 month old infant was incidentally found to have a 7.6cm right sided retroperitoneal tumor on routine screening ultrasonography for left ureteral stenosis. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 21, 2016 Category: Pathology Authors: Divya Sharma, Girish Subbarao, Romil Saxena Source Type: research
Primary Mesenchymal Liver Tumors of Childhood
Primary mesenchymal tumors of the liver represent a significant proportion of liver tumors among neonates, infants and young children. They may be discovered incidentally or present with an alarmingly large, rapidly growing abdominal mass. One third of pediatric liver tumors are benign with hemangioendothelioma and mesenchymal hamartoma being the commonest in that order. Infantile hemangioendothelioma and mesenchymal hamartoma represent the commonest liver tumors among neonates and infants. Mesenchymal hamartoma may even present in utero. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 21, 2016 Category: Pathology Authors: Omer Saeed, Romil Saxena, FRCPath Source Type: research
Diagnostic histopathology of hepatocellular carcinoma: a case-based review
Hepatocellular carcinoma, a malignant neoplasm of hepatocytes in the liver, is the most common primary hepatic malignant neoplasm in adults. In men, it is the third leading cause of cancer death in less developed countries and the sixth leading cause of cancer death in more developed countries,1 remaining asymptomatic for much of its natural course. A multidisciplinary approach for surveillance and early diagnosis of hepatocellular carcinoma (HCC) in high risk populations, combined with advances in surgical and other forms of ablative or chemotherapy, has greatly improved outcomes for patients with this tumor. (Source: Sem...
Source: Seminars in Diagnostic Pathology - December 21, 2016 Category: Pathology Authors: Rashmi M. Agni Source Type: research
Hepatocellular Adenoma: Classification, Variants and Clinical Relevance
Hepatocellular adenomas are benign tumors with two major complications, bleeding and malignant transformation. The overall narrative of hepatocellular adenoma has evolved over time. Solitary or multiple hepatocellular developing in the normal liver of women of child bearing age exposed to oral contraceptives still represents the most frequent clinical context, however, new associations are being recognized. Hepatocellular adenoma is discovered on a background of liver diseases such as non-alcoholic steatohepatitis, vascular diseases, and alcoholic cirrhosis. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 20, 2016 Category: Pathology Authors: Paulette Bioulac-Sage, Christine Sempoux, Charles Balabaud Source Type: research
Well-differentiated hepatocellular nodule: Making a diagnosis on biopsy and resection specimens of patients with advanced stage chronic liver disease
Guided liver biopsy is commonly employed to determine the identity of distinct hepatic nodules detected on imaging studies of patients with advanced stage chronic liver diseases. Discrimination among large regenerative nodule, dysplastic nodule and well-differentiated hepatocellular carcinoma is often difficult and relies on subtle histologic findings. Sampling is an important consideration in biopsy material, as compared to resection specimens, because the diagnostic features may be focal within the nodule. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 20, 2016 Category: Pathology Authors: Prodromos Hytiroglou Source Type: research
The diagnosis and treatment of hepatocellular carcinoma
As of 2008, hepatocellular carcinoma (HCC) was the 5th and 7th most common cancer in adult men and women, and the 2nd and 6th leading cause of cancer death worldwide, respectively [1]. The number of deaths worldwide, 695,900 in 2008, was nearly equal to the annual incidence of 748,300 newly diagnosed HCCs in 2008, nearly 80% of which were attributed to chronic hepatitis B and C [2]. In developing countries for instance, HBV and HCV are responsible for 60% and 33% of HCC respectively, versus 23% and 20% in developed countries [3]. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 20, 2016 Category: Pathology Authors: Justin Hartke, Matthew Johnson, Marwan Ghabril Source Type: research
Biliary tumors with pancreatic counterparts
Some biliary diseases mimic pancreatic diseases pathologically as well as pathogenetically. Such diseases can be called “biliary diseases with pancreatic counterparts”. Biliary intraepithelial neoplasm (BilIN), intraductal papillary neoplasm of bile ducts (IPNB), hepatobiliary mucinous cystic neoplasm (hMCN), and IgG4-inflammatory pseudotumor represent the biliary counterparts of pancreatic intraepithelial neopla sm (PanIN), intraductal papillary mucinous neoplasm of pancreas (IPMN), pancreatic MCN, and mass forming type 1 autoimmune pancreatitis (AIP), respectively. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 20, 2016 Category: Pathology Authors: Yasuni Nakanuma, Yoshiko Sudo Source Type: research
Bullous, pseudobullous, & pustular dermatoses
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. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 13, 2016 Category: Pathology Authors: Mark R. Wick Source Type: research
Disorders Characterized By Predominant Or Exclusive Dermal Inflammation
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. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 13, 2016 Category: Pathology Authors: Mark R. Wick Source Type: research
Granulomatous & histiocytic dermatitides
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. (Source: Seminars in Diagnostic Pathology)
Source: Seminars in Diagnostic Pathology - December 13, 2016 Category: Pathology Authors: Mark R. Wick Source Type: research
Psoriasiform dermatitides: a brief review
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 inflamma tion, 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. (Sour...
Source: Seminars in Diagnostic Pathology - December 12, 2016 Category: Pathology Authors: Mark R. Wick Source Type: research
A new molecular paradigm in mycosis fungoides and S ézary syndrome
Mycosis Fungoides (MF) and S ézary Syndrome (SS) are clonal proliferations of mature T-cells manifesting as lymphoproliferative disorders in which the neoplastic cells show a strong propensity for skin-homing. While the predominant site of presentation in MF is the skin, the peripheral blood carries a significant tumor burden in Sézary Syndrome such that it resembles a “leukemic” disease. While the genetic basis of these diseases has been studied using different approaches in the previous years, recent genome-wide studies employing massively parallel sequencing techniques now offer new insights into the molecular pa ...
Source: Seminars in Diagnostic Pathology - December 5, 2016 Category: Pathology Authors: Kojo S.J. Elenitoba-Johnson, Ryan Wilcox Source Type: research
