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CAP Home > CAP Reference Resources and Publications > CAP TODAY > CAP TODAY 2004 Archive > July 2004 Anatomic Pathology
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  Anatomic Abstracts

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cap today

July 2004

Editors:
Michael Cibull, MD, professor of pathology and laboratory medicine and director of surgical pathology, University of Kentucky Medical Center, Lexington
Subodh Lele, MD assistant professor of pathology and laboratory medicine, University of Kentucky Medical Center
Melissa Kesler, MD, hematopathology fellow, University of Texas Southwestern Medical Center at Dallas

Pathologic findings from 12-year observations involving lobular carcinoma in situ
Use of core needle biopsy diagnosis in assessing papillary breast lesions
Quality of colon carcinoma pathology reporting: a process of care study
Immunohistochemical assay to detect overexpression of TFE3

Pathologic findings from 12-year observations involving lobular carcinoma in situ

The authors conducted a 12-year clinicopathologic update of an earlier five-year analysis of 180 patients with lobular carcinoma in situ who were treated with only local excision and subsequent surveillance. Nineteen pathologic characteristics of lobular carcinoma in situ (LCIS) were assessed as potential predictors of invasive and noninvasive ipsilateral breast tumor recurrence (IBTR) and contralateral breast tumor recurrence (CBTR) as well as mortality. Only 26 IBTRs (14.4 percent) and 14 CBTRs (7.8 percent) were observed. Nine IBTRs (five percent of the total cohort) and 10 CBTRs (5.6 percent of the total cohort) were invasive carcinomas. Eight of nine IBTRs (88.9 percent) and six of eight invasive CBTRs (75 percent) that had histologic sections available for review were of the lobular invasive type. Ninety-six percent of all IBTRs and 100 percent of invasive IBTRs occurred within the same site as the index LCIS. The numbers of invasive IBTRs were comparable within and after five years (five invasive IBTRs versus four IBTRs). Recurrences of invasive CBTR occurred later than recurrences of invasive IBTR, with 70 percent of invasive CBTRs recognized after five years, compared with 44 percent of invasive IBTRs. It was found that grade two-three LCIS was significantly predictive for invasive IBTR when combined with the number of recurrences of ductal carcinoma in situ (DCIS) alone or with LCIS. Only two patients in the cohort (1.1 percent) succumbed to breast carcinoma—one had a prior invasive IBTR and the other had an invasive CBTR. The authors concluded that LCIS is a more indolent form of in situ breast carcinoma than DCIS, with which it shares other features of its natural history, particularly very low mortality rates. The authors recommended conservative surgical treatment of LCIS. They acknowledged that their findings are based on relatively few events and, even at 12 years, may be regarded as preliminary. Nonetheless, their findings may reflect the true biologic nature of LCIS.

Fisher ER, Land SR, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast and Bowel Project; twelve-year observations concerning lobular carcinoma in situ. Cancer. 2004;100:238-244.

Reprints: Dr. Edwin R. Fisher, Allegheny Cancer Center, Fifth Floor, Allegheny General Hospital, 320 E. North Ave., Pittsburgh, PA 15212; breinhar@wpahs.org

Use of core needle biopsy diagnosis in assessing papillary breast lesions

The authors conducted a study to determine the accuracy of core needle biopsy diagnosis of papillary breast lesions and to identify histologic features that can predict malignancy. They retrospectively reviewed 2,876 core needle biopsies (CNB) performed at M.D. Anderson Cancer Center from January 1995 through August 2002 and identified 50 papillary lesions: 30 papillomas, eight atypical papillomas, and 12 papillary carcinomas. Histopathological parameters were evaluated and radiographic findings were reviewed. When available, the CNB was compared with excisional biopsy material. Carcinoma was confirmed by excisional biopsy in 11 of 12 cases, and invasion was correctly assessed in 67 percent of them. In excisional biopsy, six of eight (75 percent) atypical papillomas revealed carcinoma in situ or atypia and the remaining two (25 percent) were benign; six out of 30 (20 percent) papillomas had been excised and none had shown atypia; and the remaining patients had clinical and radiological followup with no evidence of disease progression. The authors concluded that CNB is effective for assessing papillary breast lesions and that excisional biopsy is more accurate in determining invasion. Cellular monotony, lack of myoepithelial cells, and cytologic atypia are more accurate predictors of malignancy (P<0.0001) than is the presence of mitoses (P<0.053). A diagnosis of carcinoma or atypical papilloma by CNB should warrant an excisional biopsy, whereas benign papillomas may be followed if imaging findings are concordant.

Ivan D, Selinko V, Sahin A, et al. Accuracy of core needle biopsy diagnosis in assessing papillary breast lesions: histologic predictors of malignancy. Mod Pathol. 2004;17: 165-171.

Reprints: L.P. Middleton, Dept. of Pathology, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 85, Houston, TX 77030; lpmiddleton@mdanderson.org

Quality of colon carcinoma pathology reporting: a process of care study

In 1996, the Association of Directors of Anatomic and Surgical Pathology, or ADASP, published recommendations for colon carcinoma reporting. Based on this, the authors conducted a study to describe pathology reporting for colon carcinoma, evaluate potential variations in reporting, and identify areas for improvement. They obtained data from a population-based study of incident colon carcinoma in 33 counties in North Carolina between 1997 and 2000. Subjects with surgically resected colon carcinoma of tumor stage T2-T4 with available surgical pathology reports were eligible to participate in the study. The authors reviewed pathology reports for adherence to recommendations of the ADASP. They included 438 pathology reports in their analysis. Adherence to ADASP recommendations was less than 90 percent for descriptions of how a specimen was received (68 percent), how a specimen was identified (71 percent), macroscopic depth of penetration (82 percent), appearance of serosa adjacent to tumor (50 percent), and status of residual bowel (73 percent). All other criteria were reported in more than 90 percent of patients. Teaching hospitals and contract pathology laboratories had greater adherence to the recommendations than did community hospital laboratories. And hospitals with the highest colon carcinoma case volume demonstrated greater adherence to the recommendations than did low-volume hospitals. Pathology reports were effective in communicating most pertinent findings from surgically resected colon carcinoma specimens. Omission of some critical characteristics did occur, however, and significant variability in reporting existed based on laboratory affiliation and hospital case volume.

Wei JT, Miller EA, Woosley JT, et al. Quality of colon carcinoma pathology reporting: a process of care study. Cancer. 2004;100:1262-1267.

Reprints: Dr. Jeffrey T. Wei, CB 7080, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7080; jwei@med.unc.edu

Immunohistochemical assay to detect overexpression of TFE3

Recent reports have described renal carcinomas with TFE3 gene fusions that may be mistaken for other renal cell carcinoma subtypes due to a somewhat similar morphologic appearance. Since the genetic alteration in such tumors is different from that noted in the conventional (clear) cell renal carcinomas, which they closely resemble in terms of morphology, their prognosis and response to therapeutic modalities may differ. TFE3 gene fusion has also been described in alveolar soft part sarcoma (ASPS). The authors conducted a study involving an immunohistochemical assay to detect overexpression of TFE3 protein (2+ or 3+ intense nuclear staining) that was 99.6 percent specific (of 1,476 tumors from different sites, excluding renal TFE3 related carcinomas and ASPS, six were positive) and 97.5 percent sensitive (39 of 40 tumors with TFE3 gene fusion). The one case that did not stain was fixed in Bouin’s solution. Among the six of 1,476 tumors that were positive were adrenal cortical carcinoma (two of 60), granular cell tumor (two of eight), distal common bile duct carcinoma (one of 15), and high-grade myxofibrosarcoma (one of two). However, only one of these six cases was tested to confirm the absence of TFE3-related gene fusion. Seven of eight pediatric renal carcinomas that were suspected to have TFE3 fusion proteins based on assessment of morphologic features were positive by the immunoassay. The authors concluded that the assay appears to be useful in distinguishing TFE3 gene fusion-related renal carcinoma and ASPS from their mimics.

Argani P, Lal P, Hutchinson B, et al. Aberrant nuclear immunoreactivity for TFE3 in neoplasms with TFE3 gene fusions: a sensitive and specific immunohistochemical assay.

Reprints: Dr. Marc Ladanyi, Dept. of Pathology, Room S-801, Memorial-Sloan Kettering Cancer Center, 1275 York Ave., New York, NY 10021; ladanyim@mskcc.org

   
 

 

 

   
 
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