Inter-observer Variability in the Diagnosis of Proliferative Verrucous Leukoplakia: Clinical Implications for Oral and Maxillofacial Surgeon Understanding: A Collaborative Pilot Study.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Upadhyaya JD, Fitzpatrick SG, Cohen DM, Bilodeau EA, Bhattacharyya I, Lewis JS Jr, Lai J, Wright JM, Bishop JA, Leon ME, Islam MN, Seethala R, Padilla RJ, Carlos R, Müller S, Thompson LDR.
Head Neck Pathol. 2020 Mar;14(1):156-165. doi: 10.1007/s12105-019-01035-z. Epub 2019 Apr 10.
The use of diverse terminology may lead to inconsistent diagnosis and subsequent mistreatment of lesions within the proliferative verrucous leukoplakia (PVL) spectrum. The objectives of this study were: (a) to measure inter-observer variability between a variety of pathologists diagnosing PVL lesions; and (b) to evaluate the impact of diverse terminologies on understanding, interpretation, and subsequent treatment planning by oral and maxillofacial surgeons (OMFS). Six oral pathologists (OP) and six head and neck pathologists (HNP) reviewed 40 digitally scanned slides of PVL-type lesions. Inter-observer agreement on diagnoses was evaluated by Fleiss’ kappa analysis. The most commonly used diagnostic terminologies were sent to ten OMFS to evaluate their resulting interpretations and potential follow-up treatment approaches. The overall means of the surgeons’ responses were compared by Student t test. There was poor inter-observer agreement between pathologists on the diagnosis of PVL lesions (κ = 0.270), although there was good agreement (κ = 0.650) when diagnosing frankly malignant lesions. The lowest agreement was in diagnosing verrucous hyperplasia (VH) with/without dysplasia, atypical epithelial proliferation (AEP), and verrucous carcinoma (VC). The OMFS showed the lowest agreement on identical categories of non-malignant diagnoses, specifically VH and AEP. This study demonstrates a lack of standardized terminology and diagnostic criteria for the spectrum of PVL lesions. We recommend adopting standardized criteria and terminology, proposed and established by an expert panel white paper, to assist pathologists and clinicians in uniformly diagnosing and managing PVL spectrum lesions.
PubMed ID: 30972634
Article Size: 2.2 MB

Thyroid Gland Solitary Fibrous Tumor: Report of 3 Cases and a Comprehensive Review of the Literature

Endocrine, Thyroid
Thompson LDR, Wei C, Rooper LM, Lau SK.
Head Neck Pathol. 2019 Dec;13(4):597-605. doi: 10.1007/s12105-019-01012-6. Epub 2019 Feb 13.
Solitary fibrous tumors of the thyroid gland are exceptionally rare. In order to further characterize the clinical and pathologic features of solitary fibrous tumor arising at this anatomic site, three cases of thyroid gland solitary fibrous tumor were analyzed in conjunction with 35 cases compiled from the English literature. Thyroid gland solitary fibrous tumors showed an equal sex distribution with a mean age at presentation of 54.4 years (range, 28-88 years). The patients typically presented with an asymptomatic, slow growing neck mass. Microscopically, the tumors were characterized by cytologically bland spindle cells with patternless growth, hypocellular and hypercellular areas, variable amounts of collagen, and ectatic, branching blood vessels. Two previous reported tumors were considered to be histologically malignant on the basis of increased mitotic activity, profound pleomorphism and tumor necrosis. Immunohistochemically, the tumor cells are variably positive with CD34, bcl-2, and CD99. STAT6 immunohistochemistry, performed on the current cases, demonstrated a strong, diffuse nuclear expression in all tumors. Among 26 patients with available follow up data (mean 47.3 months), one developed local recurrence and distant metastasis. Solitary fibrous tumors occurring in the thyroid gland are uncommon, but can be reliably diagnosed based on the presence of characteristic morphologic features as well as immunohistochemical expression of STAT6 and CD34. The majority of thyroid gland solitary fibrous tumors have exhibited an indolent clinical course, however experience is limited. The rare potential for aggressive clinical behavior requires clinical surveillance.
PubMed ID: 30758754
Article Size: 2.6 MB

Meaningful Value Added by Standardized, Internationally Validated, and Evidence-Based Pathology Data Sets for Cancer Reporting of Head and Neck Sites Coordinated by the International Collaboration on Cancer Reporting.

Staging
Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):422-423. doi: 10.5858/arpa.2018-0489-ED.
This is an introduction to the Special Section–Structured Reporting Data Sets for Head and Neck Tumors From the International Collaboration on Cancer Reporting, Part I
PubMed ID: 30920861
Article Size: <1 MB

A Rainbow of Colors and Spectrum of Textures: An Approach to Oral Mucosal Entities.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Nelson BL, Thompson LDR.
Head Neck Pathol. 2019 Mar;13(1):1-3. doi: 10.1007/s12105-019-01007-3. Epub 2019 Jan 29.
FIRST PARAGRAPH: Nearly all surgical pathologists will encounter oral mucosal biopsies in their day to day practice. Many of these biopsies are fraught with diagnostic difficulty and may be challenging, usually due to inadequate clinical information, an unfamiliarity with anatomic landmarks and/or terminology used by the submitting physician or dentist, and the often limited size of the sample. A clinical description and history to accompany the submitted biopsy is often essential to the proper diagnosis and subsequent treatment of many oral conditions. A clinical history is a requirement recognized by the College of American Pathologist (CAP). The value and utility of a clinical history in the practice of pathology is undisputed. However, between 5.9 and 8.4% of cases submitted for pathologic review have no clinical history, or include vague information like “lesion,” “bump” or “ulcer.” Often the exact anatomic site is not included, stating only “oral cavity,” or “soft tissue” without any further designation as to exact anatomic site. This lack of important information may result in less than ideal interpretations. Additionally, concise clinical histories have been associated with shorter sign-out turnaround times. Pathologists find it too difficult to communicate with providers to obtain additional clinical information, claiming they are not in the office, they don’t return messages, or clinicians are too busy to be bothered. With nearly ubiquitous access to photography, the old adage, “A picture is worth a thousand words,” would seem to go a long way towards providing further clinical information. The clinical appearance, with the various nuances of color, texture and location are well suited to clinical photography. Cerroni et al., studied the utility of submitting clinical photographs with biopsy requests to dermatopathologists. The study showed that clinical photographs facilitated better pathology interpretation. Further, Ferrara et al., highlighted that clinical photographs do not introduce bias into the diagnosis of melanocytic lesion of the skin. There is a long held misconception by many physicians and dentists that clinically describing the sampled lesion unduly biases the pathologist: how patently false. Clear and concise clinical descriptions of mucosal lesions are essential to developing an appropriate differential diagnosis and a subsequent accurate interpretation. In an effort to highlight the importance of these characteristics, the topics covered by the contributing authors to this special issue have been divided by color, texture and location.
PubMed ID: 30693461
Article Size: <1 MB

Genetic Characteristics of Aldosterone-Producing Adenomas in Blacks

Adrenal, Endocrine
Nanba K, Omata K, Gomez-Sanchez CE, Stratakis CA, Demidowich AP, Suzuki M, Thompson LDR, Cohen DL, Luther JM, Gellert L, Vaidya A, Barletta JA, Else T, Giordano TJ, Tomlins SA, Rainey WE.
Hypertension. 2019 Apr;73(4):885-892. doi: 10.1161/HYPERTENSIONAHA.118.12070.
Somatic mutations have been identified in aldosterone-producing adenomas (APAs) in genes that include KCNJ5, ATP1A1, ATP2B3, and CACNA1D. Based on independent studies, there appears to be racial differences in the prevalence of somatic KCNJ5 mutations, particularly between East Asians and Europeans. Despite the high cardiovascular disease mortality of blacks, there have been no studies focusing on somatic mutations in APAs in this population. In the present study, we investigated genetic characteristics of APAs in blacks using a CYP11B2 (aldosterone synthase) immunohistochemistry-guided next-generation sequencing approach. The adrenal glands with adrenocortical adenomas from 79 black patients with primary aldosteronism were studied. Seventy-three tumors from 69 adrenal glands were confirmed to be APAs by CYP11B2 immunohistochemistry. Sixty-five of 73 APAs (89%) had somatic mutations in aldosterone-driver genes. Somatic CACNA1D mutations were the most prevalent genetic alteration (42%), followed by KCNJ5 (34%), ATP1A1 (8%), and ATP2B3 mutations (4%). CACNA1D mutations were more often observed in APAs from males than those from females (55% versus 29%, P=0.033), whereas KCNJ5 mutations were more prevalent in APAs from females compared with those from males (57% versus 13%, P<0.001). No somatic mutations in aldosterone-driver genes were identified in tumors without CYP11B2 expression. In conclusion, 89% of APAs in blacks harbor aldosterone-driving mutations, and unlike Europeans and East Asians, the most frequently mutated aldosterone-driver gene was CACNA1D. Determination of racial differences in the prevalence of aldosterone-driver gene mutations may facilitate the development of personalized medicines for patients with primary aldosteronism.
PubMed ID: 30739536
Article Size: <1 MB

Radiographic nodal prognostic factors in stage I HPV-related oropharyngeal squamous cell carcinoma.

Head & Neck, Oropharynx
Bhattasali O, Thompson LDR, Schumacher AJ, Iganej S.
Head Neck. 2019 Feb;41(2):398-402. doi: 10.1002/hed.25504.
BACKGROUND: The updated AJCC Cancer Staging Manual groups all p16-positive oropharyngeal squamous cell carcinoma (OPSCC) with unilateral nodal involvement within 6 cm into the new clinical N1 classification, consolidating a heterogeneous group of disease with varying radiographic findings.
METHODS: A central radiological review was conducted identifying 233 patients with stage I node-positive (cT1-2N1) disease who underwent definitive concurrent chemoradiation. Factors evaluated included lymph node size, low-neck lymphadenopathy, retropharyngeal lymphadenopathy, overt radiographic extracapsular extension, and matted lymphadenopathy.
RESULTS: On multivariate analysis adjusted for age, smoking history, and chemotherapy regimen, low-neck lymphadenopathy (hazard ratio (HR) = 6.55; P < .001) and retropharyngeal lymphadenopathy (HR = 3.36; P = .009) predicted for inferior progression-free survival (PFS). low-neck lymphadenopathy (HR = 6.38; P = .001) and retropharyngeal lymphadenopathy (HR = 3.32; P = .02) also predicted for inferior overall survival (OS). All other radiographic characteristics showed no prognostic impact for PFS or OS.
CONCLUSIONS: This analysis suggests that caution should be advised against de-intensification efforts among patients with stage I node-positive p16-positive OPSCC with low-neck lymphadenopathy or retropharyngeal lymphadenopathy.
PubMed ID: 30552839
Article Size: <1 MB
 

The HTN3-MSANTD3 Fusion Gene Defines a Subset of Acinic Cell Carcinoma of the Salivary Gland.

Head & Neck, Salivary Gland
Andreasen S, Varma S, Barasch N, Thompson LDR, Miettinen M, Rooper L, Stelow EB, Agander TK, Seethala RR, Chiosea SI, Homøe P, Wessel I, Larsen SR, Erentaite D, Bishop JA, Ulhøi BP, Kiss K, Melchior LC, Pollack JR, West RB.
Am J Surg Pathol. 2019 Apr;43(4):489-496
The spectrum of tumors arising in the salivary glands is wide and has recently been shown to harbor a network of tumor-specific fusion genes. Acinic cell carcinoma (AciCC) is one of the more frequently encountered types of salivary gland carcinoma, but it has remained a genetic orphan until recently when a fusion between the HTN3 and MSANTD3 genes was described in one case. Neither of these 2 genes is known to be implicated in any other malignancy. This study was undertaken to investigate whether the HTN3-MSANTD3 fusion is a recurrent genetic event in AciCC and whether it is a characteristic of one of its histological variants. Of the 273 AciCCs screened, 9 cases showed rearrangement of MSANTD3 by break-apart fluorescence in situ hybridization, 2 had 1 to 2 extra signals, and 1 had gain, giving a total of 4.4% with MSANTD3 aberrations. In 6 of 7 available cases with MSANTD3 rearrangement, the HTN3-MSANTD3 fusion transcript was demonstrated with real-time polymerase chain reaction . Histologically, all fusion-positive cases were predominantly composed of serous tumor cells growing in solid sheets, with serous tumor cells expressing DOG-1 and the intercalated duct-like cell component being CK7 positive and S-100 positive in 6/9 cases. All but one case arose in the parotid gland, and none of the patients experienced a recurrence during follow-up. In contrast, the case with MSANTD3 gain metastasized to the cervical lymph nodes and lungs. In conclusion, we find the HTN3-MSANTD3 gene fusion to be a recurrent event in AciCC with prominent serous differentiation and an indolent clinical course.
PubMed ID: 30520817
Article Size: <1 MB
 

Hypothalamic Vasopressin-producing Tumors: Often Inappropriate Diuresis But Occasionally Cushing Disease.

Endocrine, Pituitary
Asa SL, Ezzat S, Kelly DF, Cohan P, Takasumi Y, Barkhoudarian G, Heaney AP, Ridout R, Chik CL, Thompson LDR, Gentili F, Mete O.
Am J Surg Pathol. 2019 Feb;43(2):251-260.
Tumors of hypothalamic neurons that produce vasopressin are rare. We retrieved all cases of vasopressin-positive tumors in the sellar region from the database of the Department of Pathology. Five cases fulfilled the selection criteria, representing the first series of such tumors. Clinical, radiologic, and pathologic features were reviewed. Four tumors classified as neurocytomas were identified in 3 females and 1 male patient; the ages at onset of symptoms ranged from 17 to 40 years. All were large sellar masses with suprasellar extension and/or invasion of the parasellar sinuses. Three patients had the syndrome of inappropriate antidiuresis; in one of these, a 6-year history was initially considered to be idiopathic. One patient died of progressive disease; 3 had incomplete resections and are being followed. In contrast to these patients with neurocytoma, a 65-year-old woman had Cushing disease and a 0.8 cm mass that was completely resected at transsphenoidal surgery; this tumor was a gangliocytoma producing vasopressin associated with corticotroph hyperplasia. We postulate that the small amount of vasopressin secreted by this mature gangliocytic tumor was locally bound to corticotrophs, resulting in hyperplasia and Cushing disease, without sufficient overproduction to cause systemic effects of vasopressin excess. Hypothalamic neurocytoma is a tumor that can mimic pituitary neuroendocrine tumors and olfactory neuroblastoma but is distinguished by positivity for neurofilaments, NeuN, and TTF-1 and negative staining for adenohypophysial biomarkers. Our cases illustrate that neurocytoma and gangliocytoma are 2 variants of tumors of hypothalamic neurons that can produce vasopressin. The morphologic and proliferative features of these 2 tumor types represent 2 ends of a spectrum; their function also can result in divergent clinical manifestations, one characterized by reduced urine output and the other by the more insidious features of glucocorticoid excess.
PubMed ID: 30379651
Article Size: <1 MB
 
 
 
 

Molecular Profiling of Salivary Gland Intraductal Carcinoma Revealed a Subset of Tumors Harboring NCOA4-RET and Novel TRIM27-RET Fusions: A Report of 17 cases.

Head & Neck, Salivary Gland
Skálová A, Vanecek T, Uro-Coste E, Bishop JA, Weinreb I, Thompson LDR, de Sanctis S, Schiavo-Lena M, Laco J, Badoual C, Santana Conceiçao T, Ptáková N, Baněčkova M, Miesbauerová M, Michal M.
Am J Surg Pathol. 2018 Nov;42(11):1445-1455.
Intraductal carcinoma (IC) is the new World Health Organization designation for tumors previously called “low-grade cribriform cystadenocarcinoma” and “low-grade salivary duct carcinoma.” The relationship of IC to salivary duct carcinoma is controversial, but they now are considered to be distinct entities. IC is a rare low-grade malignant salivary gland neoplasm with features similar to mammary atypical ductal hyperplasia or ductal carcinoma in situ, that shows diffuse S100 protein and mammaglobin positivity and is only partially defined genetically. (Mammary analogue) secretory carcinoma harboring ETV6-NTRK3, and in rare cases ETV6-RET fusion, shares histomorphologic and immunophenotypical features with IC. Recently, RET rearrangements and NCOA4-RET have been described in IC, suggesting a partial genetic overlap with mammary analogue secretory carcinoma. Here, we genetically characterize the largest cohort of IC to date to further explore this relationship. Seventeen cases of IC were analyzed by next-generation sequencing using the FusionPlex Solid Tumor kit (ArcherDX). Identified fusions were confirmed using fluorescence in situ hybridization break apart and, in some cases, fusion probes, and a reverse transcription polymerase chain reaction designed specifically to the detected breakpoints. All analyzed cases were known to be negative for ETV6 rearrangement by fluorescence in situ hybridization and for ETV6-NTRK3 fusion by reverse transcription polymerase chain reaction. Next-generation sequencing analysis detected a NCOA4-RET fusion transcript joining exon 7 or 8 of NCOA4 gene and exon 12 of RET gene in 6 cases of intercalated duct type IC; and a novel TRIM27-RET fusion transcript between exons 3 and 12 in 2 cases of salivary gland tumors displaying histologic and immunohistochemical features typical of apocrine IC. A total of 47% of IC harbored a fusion involving RET. In conclusion, we have confirmed the presence of NCOA4-RET as the dominant fusion in intercalated duct type IC. A novel finding in our study has been a discovery of a subset of IC patients with apocrine variant IC harboring a novel TRIM27-RET.
PubMed ID: 30045065
Article Size: <1 MB
 

CAIX and pax-8 Commonly Immunoreactive in Endolymphatic Sac Tumors: A Clinicopathologic Study of 26 Cases with Differential Considerations for Metastatic Renal Cell Carcinoma in von Hippel-Lindau Patients.

Ear & Temporal Bone, Head & Neck
Thompson LDR, Magliocca KR, Andreasen S, Kiss K, Rooper L, Stelow E, Wenig BM, Bishop JA.
Head Neck Pathol. 2019 Sep;13(3):355-363. doi: 10.1007/s12105-018-0973-8. Epub 2018 Oct 5.
Endolymphatic sac tumors (ELSTs) are rare, slowly growing temporal bone neoplasms which show a high association with von Hippel-Lindau (VHL) syndrome. The immunohistochemistry evaluation of these papillary-cystic neoplasms frequently raises the differential diagnosis with renal cell carcinoma, among other metastatic neoplasms, whether in VHL patients or not. A cohort of 26 patients with ELSTs were evaluated for histologic features, immunohistochemistry findings, and association with VHL. Standard immunohistochemistry evaluation was performed. Sixteen females and 10 males ranging in age from 10 to 69 years (mean 44; VHL mean: 32) at initial presentation, comprised the cohort of patients. Most (86%) experienced hearing changes or inner ear symptoms (vertigo, dizziness), with an average duration of symptoms for 39 months (range 2-240 months). The tumors were an average of 2.9 cm (range 0.4-8 cm), with 14 left, 11 right sided and one bilateral tumor. Nine patients had documented VHL, with 3 patients having a concurrent or subsequent clear cell renal cell carcinoma. Patients were followed an average of 6.2 years (available in 24 patients): 19 alive without disease, 7.5 years; 2 dead without disease, 1.2 years; and 3 alive with disease, 3.1 years. The neoplastic cells show the following immunohistochemistry findings: AE1/AE3, EMA, CK7, CAIX, GLUT1, VEGF: 100% of cases tested were positive; pax-8: 85% of cases positive; CD10 and RCC: 0% of cases reactive. Based on this cohort of 26 patients with ELST, 9 of whom had VHL, the strong pax-8 and CAIX should be used in conjunction with negative CD10 and RCC to help exclude a metastatic renal cell carcinoma. As CAIX is an enzyme overexpressed in hypoxia and hypoxia inducible factor is what VHL protein regulates, this is an expected, although previously unreported finding. Whether part of VHL or not, VHL mutations may be a somatic rather than germline finding in the tumors, a possible further explanation for the CAIX reaction.
PubMed ID: 30291511
Article Size: 2 MB

Sinonasal renal cell-like adenocarcinomas: robust carbonic anhydrase expression

Head & Neck, Sinonasal Tract
Shen T, Shi Q, Velosa CM, Bai S, Thompson LDR, Keen C, Patel A, Simpson R, Wei S, Brandwein-Gensler M. Sinonasal Renal Cell-Like Adenocarcinomas: Robust Carbonic Anhydrase Expression and the Renal-Like Function of Schneiderian Mucosa
Hum Pathol. 2015 Nov;46(11):1598-606.
We report 3 new patients with sinonasal renal cell-like adenocarcinoma (SNRCLA). One case submitted in consultation demonstrated robust carbonic anhydrase IX (CA-IX) expression, leading us to a broader inquiry of CA-IX and carbonic anhydrase II (CA-II) expression in other SNRCLA, Schneiderian tissues, and histologic mimickers. Robust cytoplasmic and membranous CA-IX expression is demonstrated in 6 of 7 SNRCLAs; CA-II expression was demonstrated in 2 of 5 cases. Robust, diffuse CA-II expression is demonstrated throughout sinonasal seromucinous glands in all 10 normal Schneiderian samples. CA-IX is also expressed in all normal sinonasal samples, albeit focally. The closest salivary mimic to SNRCLA is hyalinizing salivary clear cell carcinoma; only focal CA-IX expression was demonstrated in 1 of 2 cases studied. Carbonic anhydrase expression in Schneiderian tissue speaks to its role in regulating the ion concentration of sinonasal secretions and may also explain the origin of this rare tumor.
PubMed ID: 26299508
Article Size: 4.7 MB
 
 
 
 

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Medical Techniques, Videos

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Carcinomas of the Oral Cavity (TNM8)

Head & Neck, Staging
Müller S, Boy S, Day TA, Magliocca K, Richardson MS, Sloan P, Tilakaratne WM, Zain RB, Thompson LDR.
(2018) Carcinomas of the Oral Cavity, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-19-4

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of invasive carcinomas of the oral cavity, including lip and tongue. Mucosal melanoma, lymphomas and sarcomas are not included. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – Susan Müller, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Sonja Boy, South Africa
* Terrance Day, USA
* Kelly Magliocca, USA
* Mary Richardson, USA
* Philip Sloan, UK
* WM Tilakaratne, Sri Lanka
* Rosnah B Zain, USA
ISBN: 978-1-925687-19-4
Article Size: 1.6 MB
 
Müller S, Boy S, Day TA, Magliocca K, Richardson MS, Sloan P, Tilakaratne WM, Zain RB, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):439-446. doi: 10.5858/arpa.2018-0411-SA. Epub 2018 Nov 30.
PubMed ID: 30500296
Article Size: 3.3 MB

Mucosal Melanomas of the Head and Neck (TNM8)

Head & Neck, Staging
Thompson LDR, Franchi A, Helliwell T, Müller S, Williams MD.
(2018) Mucosal Melanomas of the Head and Neck, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-25-5

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal melanoma arising in the nasopharynx, oropharynx, larynx, hypopharynx, oral cavity, nasal cavity and paranasal sinuses. All other malignancies and tumour categories are dealt with in separate datasets, specifically cutaneous melanoma is separately reported. Direct extension of a cutaneous primary into a mucosal site should be excluded, and would not be reported in this dataset. Metastasis to a head and neck mucosal site is also excluded. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair and Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Alessandro Franchi, Italy
* Tim Helliwell, UK
* Susan Müller, USA
* Michelle Williams, USA
ISBN: 978-1-925687-25-5
Article Size: 1.2 MB
 
Williams MD, Franchi A, Helliwell T, Müller S, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):603-609 doi: 10.5858/arpa.2018-0412-SA.
PubMed ID: 30500297
Article Size: 4.8 MB

Carcinomas of the Nasopharynx and Oropharynx (TNM8)

Head & Neck, Oropharynx, Staging
Lewis JS Jr, Adelstein DJ, Agaimy A, Diane Carlson D, Faquin WC, Helliwell T, Hille J, Nicholls JM, Ng T, O’Sullivan B, Thompson LDR.
(2018) Carcinomas of the Nasopharynx and Oropharynx, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-18-7

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of the nasopharynx and oropharynx. The protocol applies to all invasive carcinomas of the nasopharynx and oropharynx including the base of tongue, tonsils, soft palate, posterior wall, and uvula. Lymphomas and sarcomas are not included. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – James S Lewis Jr, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* David Adelstein, USA
* Abbas Agaimy, Germany
* Diane Carlson, USA
* William Faquin, USA
* Tim Helliwell, UK
* Jos Hille, South Africa
* John Nicholls, Hong Kong
* Tony Ng, Canada
* Brian O’Sullivan, Canada
ISBN: 978-1-925687-18-7
Article Size: 1.5 MB
 
Lewis JS Jr, Adelstein DJ, Agaimy A, Diane Carlson D, Faquin WC, Helliwell T, Hille J, Nicholls JM, Ng T, O’Sullivan B, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):447-451. doi: 10.5858/arpa.2018-0405-SA. Epub 2018 Nov 30.
PubMed ID: 30500294
Article Size: 2 MB

Carcinomas of the Nasal Cavity and Paranasal Sinuses (TNM8)

Head & Neck, Staging
Franchi A, Bishop JA, Coleman H, Flucke U, Licitra L, Llorente JL, Stelow E, Toner M, Weinreb I, Thompson LDR.
(2018) Carcinomas of the Nasal Cavity and Paranasal Sinuses, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-20-0

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal malignancies originating in the nasal cavities and paranasal sinuses. Neuroectodermal neoplasms (including melanoma) and sarcomas are not included. Bone, soft tissue and lymphoma protocols are separately listed. Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For additional independent tumours, complete a separate dataset for each.

EXPERT COMMITTEE:
* Chair – Alessandro Franchi, Italy
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Justin Bishop, USA
* Hedley Coleman, Australia
* Uta Flucke, Netherlands
* Lisa Licitra, Italy
* José L Llorente, Spain
* Edward Stelow, USA
* Mary Toner, UK
* Ilan Weinreb, Canada
ISBN: 978-1-925687-20-0
Article Size: 1.3 MB
 
Franchi A, Bishop JA, Coleman H, Flucke U, Licitra LF, Pendás JLL, Stelow EB, Toner M, Weinreb I, Wenig BM, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):424-431. doi: 10.5858/arpa.2018-0404-SA. Epub 2018 Nov 30
PubMed ID: 30500298
Article Size: 2 MB

Carcinomas of the Hypopharynx, Larynx and Trachea (TNM8)

Head & Neck, Staging
Helliwell T, Chernock R, Dahlstrom JE, Gale N, McHugh J, Perez-Ordonez B, Roland N, Zidar N, Thompson LDR.
(2018) Carcinomas of the Hypopharynx, Larynx and Trachea, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-17-0

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of mucosal malignancies of the larynx, hypopharynx and trachea. The protocol applies to all invasive carcinomas of the larynx, hypopharynx and trachea (including the supraglottis, glottis, and subglottis). Salivary-type malignancies arising from mucosal glands of the hypopharynx and larynx should be recorded in this dataset. Mucosal melanoma is presented in a separate dataset. Lymphomas and sarcomas are not included. Malignancies arising at other sites in the head and neck region, and neck dissections and nodal excisions are dealt with in separate datasets which may be used, as appropriate, in conjunction with this dataset. Where more than one anatomically or histologically distinct primary tumours occur, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair – Tim Helliwell, UK
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Rebecca Chernock, USA
* Jane Dahlstrom, Australia
* Nina Gale, Slovenia
* Jonathan McHugh, USA
* Bayardo Perez-Ordonez, Canada
* Nick Roland, UK
* Nina Zidar, Slovenia
ISBN: 978-1-925687-17-0
Article Size: 1.5 MB
 
Helliwell T, Chernock R, Dahlstrom JE, Gale N, McHugh J, Perez-Ordonez B, Roland N, Zidar N, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):432-438. doi: 10.5858/arpa.2018-0419-SA. Epub 2018 Nov 30.
PubMed ID: 30500292
Article Size: 2 MB

Ear and Temporal Bone Tumours (TNM8)

Head & Neck, Staging
Thompson LDR, Gupta R, Sandison A, Wenig BM.
(2018) Ear and Temporal Bone Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-22-4

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of the ear and temporal bone. It includes ONLY primary tumours of the external auditory canal, middle and inner ear, including both benign and malignant entities (specifically due to anatomic confines and management alternatives which may require significant, destructive or disfiguring surgery).

By definition, all malignancies of the external ear (pinna, concha, scaphoid, lobe, etc., such as squamous cell carcinoma, basal cell carcinoma, atypical fibroxanthoma, Merkel cell carcinoma and melanoma) are separately covered by the dermatopathology datasets.

Neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For bilateral tumours, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair and Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Ruta Gupta, Australia
* Ann Sandison, UK
* Bruce Wenig, USA
ISBN: 978-1-925687-22-4
Article Size: 1.4 MB
 
Gupta R, Sandison A, Wenig BM, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):593 602. doi: 10.5858/arpa.2018-0415-SA.
PubMed ID: 30500288
Article Size: 4.7 MB

Carcinomas of the Major Salivary Glands (TNM8)

Head & Neck, Staging
Seethala RR, Altemani A, Ferris RL, Fonseca I, Gnepp DR, Ha P, Nagao T, Skalova A, Stenman G, Thompson LDR.
(2018) Carcinomas of the Major Salivary Glands, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-21-7

SCOPE:

The dataset has been developed for the reporting of resection and biopsy specimens of malignant neoplasms and associated carcinoma in situ arising from the major salivary glands. The protocol applies to all carcinomas of the parotid, submandibular and sublingual glands. Melanomas, lymphomas, and sarcomas are dealt with in separate datasets. Minor salivary gland malignancies arising in the oral cavity, nasal cavity and paranasal sinuses, trachea, nasopharynx, oropharynx and hypopharynx and odontogenic specimens are staged according to their anatomical sub-site and are dealt with in separate datasets. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable. For bilateral tumours, a separate dataset should be completed for each tumour.

EXPERT COMMITTEE:
* Chair – Raja Seethala, USA
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Albina Altemani, Brazil
* Robert L Ferris, USA
* Isabel Fonseca, Portugal
* Douglas Gnepp, USA
* Patrick Ha, USA
* Toshitaka Nagao, Japan
* Alena Skalova, Czech Republic
* Göran Stenman, Sweden
ISBN: 978-1-925687-21-7
Article Size: 1.3 MB
 
Seethala RR, Altemani A, Ferris RL, Fonseca I, Gnepp DR, Ha P, Nagao T, Skalova A, Stenman G, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):578-586. doi: 10.5858/arpa.2018-0422-SA.
PubMed ID: 30500293
Article Size: 3.4 MB

Malignant Odontogenic Tumours (TNM8)

Head & Neck, Staging
Odell E, Baumhoer D, Carlos R, Hunter KD, Mosqueda-Taylor A, Richardson M, Slater L, Slootweg PJ, Speight P, Wright J, Thompson LDR.
(2018) Malignant Odontogenic Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-23-1

SCOPE:

The dataset has been developed for the reporting of biopsy and resection specimens for malignant primary odontogenic tumours. Malignant neoplasms arising in the nasal cavity and paranasal sinuses, oral cavity, salivary glands, trachea, pharynx and larynx are dealt with in separate datasets. Bone, soft tissue and lymphoma protocols will be separately listed. In addition, neck dissections and nodal excisions are dealt with in a separate dataset, and this dataset should be used in conjunction, where applicable.

EXPERT COMMITTEE:
* Chair – Edward Odell, UK
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Daniel Baumhoer, Switzerland
* Roman Carlos, Guatemala
* Keith Hunter, UK
* Adalberto Mosqueda-Taylor, Mexico
* Mary Richardson, USA
* Lee Slater, USA
* Pieter Slootweg, Netherlands
* Paul Speight, UK
* John Wright, USA
ISBN: 978-1-925687-23-1
Article Size: 1.3 MB
 
Slootweg PJ, Odell EW, Baumhoer D, Carlos R, Hunter KD, Taylor AM, Richardson MS, Slater L, Speight PM, Wright J, Thompson LDR.
Arch Pathol Lab Med. 2019 May;143(5):587-592. doi: 10.5858/arpa.2018-0417-SA.
PubMed ID: 30500289
Article Size: 2.9 MB

Nodal Excisions and Neck Dissection Specimens for Head & Neck Tumours (TNM8)

Head & Neck, Staging
Bullock M, Beitler JJ, Carlson DL, Fonseca I, Hunt J, Katabi N, Sloan P, Taylor SM, Williams MD, Thompson LDR.
(2018) Nodal Excisions and Neck Dissection Specimens for Head & Neck Tumours, Histopathology Reporting Guide, 1st Edition. International Collaboration on Cancer Reporting; Sydney, Australia. ISBN: 978-1-925687-24-8

SCOPE:

The dataset has been developed for the reporting of lymph node resections from patients with carcinomas and melanomas of the head and neck. This excludes nodal resections for lymphoma and sarcomas. It is not intended for use in reporting lymph node core biopsy or fine needle aspirations. Carcinomas covered by the dataset include squamous cell carcinomas, sinonasal carcinomas, salivary and non-salivary type adenocarcinomas and neuroendocrine tumours. Pathologists may also apply the dataset to metastatic non-Merkel cutaneous squamous cell carcinomas and other cutaneous carcinomas. This dataset is to be used in conjunction with other datasets in the Head and Neck Series.

EXPERT COMMITTEE:
* Chair – Martin Bullock, Canada
* Series Champion – Lester Thompson, USA
DOMAIN EXPERTS:
* Jonathan Beitler, USA
* Diane L. Carlson, USA
* Isabel Fonseca, Portugal
* Jennifer Hunt, USA
* Nora Katabi, USA
* Philip Sloan, UK
* S. Mark Taylor, Canada
* Michelle Williams, USA
ISBN: 978-1-925687-24-8
Article Size: 2 MB
 
Bullock M, Beitler JJ, Carlson DL, Fonseca I, Hunt J, Katabi N, Sloan P, Taylor SM, Williams MD, Thompson LDR.
Arch Pathol Lab Med. 2019 Apr;143(4):452-462. doi: 10.5858/arpa.2018-0421-SA. Epub 2018 Nov 30.
PubMed ID: 30500291
Article Size: 4.8 MB

Comparison of high-dose Cisplatin-based chemoradiotherapy and Cetuximab-based bioradiotherapy for p16-positive oropharyngeal squamous cell carcinoma in the context of revised HPV-based staging

Head & Neck, Oropharynx
Bhattasali O, Thompson LDR, Abdalla IA, Chen J, Iganej S.
Rep Pract Oncol Radiother 23 (2018) 451-457.
Aim: To perform a comparison of Cisplatin vs. Cetuximab in p16-positive oropharyngealsquamous cell carcinoma (OPSCC) in the context of the revised HPV-based staging.
Background: Previous reports comparing these agents in head and neck cancer haveincluded heterogenous disease and p16-status.
Materials and methods: A retrospective review was conducted from 2006 to 2016 ofpatients with p16-positive OPSCC who underwent definitive radiotherapy concurrent witheither triweekly Cisplatin (n = 251) or Cetuximab (n = 40). AJCC 8th Edition staging wasadapted.
Results: Median follow-up for surviving patients was 40 months. On multivariate analysisfor all-comers, comparing Cisplatin and Cetuximab, 3-year locoregional recurrence (LRR):6% vs. 16% (p = 0.07), 3-year distant metastasis (DM): 8% vs. 21% (p = 0.04), 3-year overallrecurrence rate (ORR): 11% vs. 29% (p = 0.01), and 3-year cause-specific survival (CSS): 94%vs. 79% (p = 0.06), respectively. On stage-based subgroup analysis, for stage I II disease, 3-year LRR: 5% vs. 10% (p = 0.51), 3-year DM: 7% vs. 16% (p = 0.32), 3-year ORR: 10% vs. 23%(p = 0.15), and 3-year CSS: 95% vs. 82% (p = 0.38). For stage III disease, 3-year LRR: 10% vs. 40%(p = 0.07), 3-year DM: 9% vs. 43% (p = 0.07), 3-year ORR: 15% vs. 55% (p = 0.04), and 3-year CSS:94% vs. 57% (p = 0.048).
Conclusions: When given concurrently with radiotherapy, Cetuximab and triweekly Cisplatin demonstrated comparable efficacy for AJCC 8th Edition stage I–II p16-positive OPSCC. However, Cetuximab appeared to be associated with higher rates of treatment failure and cancer-related deaths in stage III disease. Upon availability of the RTOG 1016 trial results, analysis based on the revised HPV-based staging should be performed to confirm these
findings.
PubMed ID: n/a
Article Size: <1 MB
 

Ectomesenchymal Chondromyxoid Tumor: A Neoplasm Characterized by Recurrent RREB1-MKL2 Fusions.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Dickson BC, Antonescu CR, Argyris PP, Bilodeau EA, Bullock MJ, Freedman PD, Gnepp DR, Jordan RC, Koutlas IG, Lee CH, Leong I, Merzianu M, Purgina BM, Thompson LDR, Wehrli B, Wright JM, Swanson D, Zhang L, Bishop JA.
Am J Surg Pathol. 2018 Oct;42(10):1297-1305.
Ectomesenchymal chondromyxoid tumor is a rare and benign neoplasm with a predilection for the anterior dorsal tongue. Despite morphologic heterogeneity, most cases are characterized by a proliferation of bland spindle cells with a distinctive reticular growth pattern and myxoid stroma. The immunophenotype of these neoplasms is likewise variable; most cases express glial fibrillary acid protein and S100 protein, with inconsistent reports of keratin and myoid marker expression. The molecular pathogenesis is poorly understood; however, a subset of cases has been reported to harbor EWSR1 gene rearrangement. Following identification of an RREB1-MKL2 fusion gene by RNA Sequencing in an index patient, a retrospective review of additional cases of ectomesenchymal chondromyxoid tumors was performed to better characterize the clinical, immunohistochemical, and molecular attributes of this neoplasm. A total of 21 cases were included in this series. A marked predisposition for the dorsal tongue was confirmed. Most cases conformed to prior morphologic descriptions; however, hypercellularity, hyalinized stroma, and necrosis were rare attributes not previously emphasized. The neoplastic cells frequently coexpressed glial fibrillary acid protein, S100 protein, keratin, smooth muscle actin, and/or desmin; a single case was found to contain significant myogenin expression. An RREB1-MKL2 fusion product was identified in 19 tumors (90%), a single tumor (5%) had an EWSR1-CREM fusion product, and the remaining case lacked any known fusion gene by RNA Sequencing. The latter 2 cases subtly differed morphologically from many in the cohort. This series illustrates that recurrent RREB1-MKL2 fusions occur in most, perhaps all, cases of ectomesenchymal chondromyxoid tumor.
PubMed ID: 29912715
Article Size: 1 MB
 

Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features (NIFTP): Achieving Better Agreement by Refining Diagnostic Criteria

Endocrine, Thyroid
Alves VAF, Kakudo K, LiVolsi V, Lloyd RV, Nikiforov YE, Nosé V, Papotti M, Thompson LDR.
Clinics (Sao Paulo). 2018 May 21;73:e576.
FIRST PARAGRAPH: Over the past decade, improvements in imaging technologies along with greater access to medical care have resulted in the discovery of neoplasms in a much earlier stage. This has contributed to a reduction in cancer mortality. However, an unintended consequence of early detection has been detection of lesions which present at an earlier pathologic stage of development, requiring modification of diagnostic criteria, as well as determining a more appropriate risk stratification to inform management.
PubMed ID: 29791602
Article Size: <1 MB

Measuring Depth of Invasion in Early Squamous Cell Carcinoma of the Oral Tongue: Positive Deep Margin, Extratumoral Perineural Invasion, and Other Challenges.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Berdugo J, Thompson LDR, Purgina B, Sturgis CD, Tuluc M, Seethala R, Chiosea SI.
Head Neck Pathol. 2019 Jun;13(2):154-161.
doi: 10.1007/s12105-018-0925-3. Epub 2018 Apr 26.
The 8th edition of American Joint Committee on Cancer (AJCC 8th) staging manual incorporated depth of invasion (DOI) into pT stage of oral cavity cancer. The aim of this study was to characterize several histological findings that may complicate measurement of DOI in early conventional squamous cell carcinomas (SCC) of the oral tongue: (1) lack of or minimal residual carcinoma following biopsy; (2) positive deep margin; (3) extratumoral perineural invasion (PNI); and (4) lymphatic or vascular invasion. Conventional SCC of the oral tongue (n = 407) with the largest dimension of ≤ 4 cm and with a negative elective cervical lymph node dissection (pN0) were reviewed. A clear plastic ruler was used to measure DOI by dropping a “plumb line” to the deepest point of the invasive tumor from the level of the basement membrane of the normal mucosa closest to the invasive tumor. Examples of identifying reference point on the mucosal surface of oral tongue from which to measure the DOI are illustrated. In the experience of one contributing institution, the residual carcinoma was absent in 14.2% of glossectomies (34/239), while in 4.8% of cases (10/205) there was only minimal residual carcinoma. In 11.5% (21/183) of pT2 cases the deep margin was positive and thus DOI and pT may be underestimated. Of all cases with PNI, extratumoral PNI was identified in 23.1% (31/134) of cases, but represented the deepest point of invasion in only two cases. In one case, lymphatic invasion represented the deepest point of invasion and could have led to upstaging from pT1 to pT2. In conclusion, DOI measurement for SCC of the oral tongue may require re-examination of the diagnostic biopsy in up to 20% of cases due to the absence or only minimal residual carcinoma in glossectomy specimens. In 11.5% of apparently pT2 cases, DOI may be underestimated due to the positive deep margin. Rarely, extratumoral PNI or lymphatic invasion may be the deepest point of invasion. Overall, two issues (absent or minimal residual disease and positive deep margin) may confound DOI measurement in early SCCs of oral tongue.
PubMed ID: 29700721
Article Size: 3 MB

Diagnostic Approach to Fine Needle Aspirations of Cystic Lesions of the Salivary Gland

Head & Neck, Salivary Gland
Pantanowitz L , Thompson LDR, Rossi ED.
Head Neck Pathol. 2018 Dec;12(4):548-561.
Fine needle aspiration (FNA) has diagnostic and therapeutic value in the management of salivary gland cysts. Rendering an accurate diagnosis from an aspirated salivary gland cyst is challenging because of the broad differential diagnosis, possibility of sampling error, frequent hypocellularity of specimens, morphologic heterogeneity, and overlapping cytomorphology of many cystic entities. To date, there have been no comprehensive review articles providing a practical diagnostic approach to FNA of cystic lesions of salivary glands. This article reviews the cytopathology of salivary gland cysts employing 2017 World Health Organization terminology, addresses the accuracy of FNA, and presents The Milan System approach for reporting in cystic salivary gland cases. The utility of separating FNA specimens from salivary gland cysts, based upon the presence of mucin and admixed lymphocytes in cyst fluid is demonstrated. A reliable approach to interpreting FNA specimens from patients with cystic salivary gland lesions is essential to accurately determine which of these patients may require subsequent surgery.
PubMed ID: 29524082
Article Size: 3.5 MB
 
 
 

Dentigerous cyst

Head & Neck, Oral Cavity/Gnathic (Jaw)
Thompson, LD.
Ear Nose Throat J. 2018 Mar;97(3):57.
FIRST PARAGRAPH: A dentigerous cyst is a development cyst that surrounds and envelops the crown of an unerupted tooth, attached at the crown-root (cemento-enamel or cervical) junction. Dentigerous cysts account for about 20% of all odontogenic cysts, developing during a peak age of 10 to 30 years, with a male predilection (3:2). The lesion presents in the mandible (3rd molar region) about twice as often as the maxilla (near maxillary canines).
PubMed ID: 29554396
Article Size: <1 MB

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in thyroid tumor classification.

Endocrine, Thyroid
Kakudo K, El-Naggar AK, Hodak SP, Khanafshar E, Nikiforov YE, Nosé V, Thompson LDR.
Pathol Int. 2018 Jun;68(6):327-333.
In 2016, a new morphological thyroid tumor entity, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), was introduced to replace a group of lowrisk tumors known as noninvasive encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC). Since then, there have been more than 60 publications with a keyword of NIFTP according to a PubMed literature survey on October 28, 2017. These publications cover many aspects on this new tumor entity, cytological diagnosis, ultrasound features, molecular genotyping, clinical management and long-term outcome of NIFTP patients. They supported an indolent nature of NIFTP even in large size (>4 cm) tumors. Under ultrasound examination, NIFTPs are usually in low-suspicion nodules while invasive EFVPTC in intermediate-suspicious nodules and infiltrative FVPTCs in high-suspicion nodules. In FNA cytology, the majority of NIFTP are classified in indeterminate (atypia of uncertain significance/follicular lesion of uncertain significance, follicular neoplasm/suspicious for follicular neoplasm or suspicious for malignancy) categories. The new 4th edition of the World Health Organization (WHO) Classification of Tumours of Endocrine Organs including thyroid tumors was published in 2017 and it incorporated a new chapter on borderline tumors of follicular cell origin. These included hyalinizing trabecular tumor, uncertain malignant potential (UMP), and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). UMP and NIFTP were incorporated as subchapters in a new chapter of other encapsulated follicular-patterned thyroid tumors (Table 1). Their behavior codes were set as /1 (unspecified, borderline, or uncertain behavior), and not /0 (benign tumors), /2 (carcinoma in situ and grade III intraepithelial neoplasia), or /3 (malignant tumors).
This editorial was written by seven authors, on behalf of all authors of the NIFTP working group, to refine diagnostic criteria for NIFTP in order to improve concordance in the diagnosis and to address several issues with the diagnosis of NIFTP raised in recent publications.
PubMed ID: 29675873
Article Size: <1 MB
 
 
 

Head and Neck Kaposi Sarcoma: Clinicopathological Analysis of 11 Cases.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Agaimy A, Mueller SK, Harrer T, Bauer S, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):511-516.
Kaposi sarcoma (KS) of the head and neck area is uncommon with limited published case series. Our routine and consultation files were reviewed for histologically and immunohistochemically proven KS affecting any cutaneous or mucosal head and neck site. Ten males and one female aged 42-78 years (median, 51 years; mean, 52 years) were retrieved. Eight patients were HIV-positive and three were HIV-negative. The affected sites were skin (n = 5), oral/oropharyngeal mucosa (n = 5), and lymph nodes (n = 3) in variable combination. The ear (pinna and external auditory canal) was affected in two cases; both were HIV-negative. Multifocal non-head and neck KS was reported in 50% of patients. At last follow-up (12-94 months; median, 46 months), most of patients were either KS-free (n = 8) or had ongoing remission under systemic maintenance therapy (n = 2). One patient was alive with KS (poor compliance). Histopathological evaluation showed classical features of KS. One case was predominantly sarcomatoid with prominent inflammation mimicking undifferentiated sarcoma. Immunohistochemistry showed consistent expression of CD31, CD34, ERG, D2-40 and HHV8 in all cases. This is one of the few series devoted to head and neck KS showing high prevalence of HIV-positivity, but also unusual presentations in HIV-negative patients with primary origin in the skin of the ear and the auditory canal. KS should be included in the differential diagnosis of difficult-to-classify spindle cell lesions at this uncommon location.
PubMed ID: 29508130
Article Size: 1.6 MB
 
 
 
 

An International Interobserver Variability Reporting of the Nuclear Scoring Criteria to Diagnose Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features: a Validation Study

Endocrine, Thyroid
Thompson LDR, Poller DN, Kakudo K, Burchette R, Nikiforov YE, Seethala RR.
Endocr Pathol. 2018 Sep;29(3):242-249.
The aim of the study was to assess interobserver variation in reporting nuclear features of encapsulated follicular variant of papillary thyroid carcinoma, newly reclassified as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP), based on a proposed standardized scoring system. An education module was individually reviewed as a pre-evaluation teaching guide of the specific features of classical papillary carcinoma, the specific inclusion and exclusion features for the diagnosis of NIFTP, and a catalog of the standardized scoring system of the nuclear features of papillary carcinoma used to reach this diagnosis. Participants subsequently reviewed 30 cases of thyroid lesions previously scored by members of the Endocrine Pathology Society Working Group for the Re-evaluation of the Encapsulated Follicular Variant of Papillary Thyroid Carcinoma. There was one uninvolved reference image to demonstrate fixation, processing, and cell size and one image from each case for scoring, with results recorded for each participant. The location of training (country and program), years as a practicing pathologist, and approximate number of thyroid gland surgical cases diagnosed per year were recorded. The degree of agreement between participants was assessed by kappa statistics, using the individual criteria and the average composite scores of the Working Group as a point of comparison. Using the Nuclear Standardized Scoring System, the interobserver agreement for final diagnosis score was generally excellent: unweighted and weighted kappa values between individual observers ranging from 0.242 to 0.930 (average 0.626). There was significant agreement between observers in reaching an interpretation of the presence or absence of nuclear features to diagnose NIFTP (score 0–1 versus score of 2–3), with California pathologists, 0.63 (median 0.66, SD 0.15); Japanese pathologists, 0.64 (median 0.66, SD 0.16); and UK pathologists, 0.60 (median 0.57, SD 014) compared to the expert panel, 0.70 (median 0.73, SD 0.19). The use of the nuclear scoring system to evaluate the nuclear features of papillary thyroid carcinoma as applied to reach the diagnosis of NIFTP shows a good to substantial interobserver agreement, suggesting that consensus can be reached in diagnosing the nuclear features required for this newly reclassified neoplasm.
PubMed ID: 29508145
Article Size: 2 MB
 
 
 
 

Induction chemotherapy followed by concurrent chemoradiation versus concurrent chemoradiation alone in the definitive management of p16-positive oropharyngeal squamous cell carcinoma with low-neck or N3 disease

Oropharynx
Bhattasalia O, Han J, Thompson LDR, Buchschacher GL Jr, Abdalla IA, Iganeja S.
Oral Oncol. 2018 Mar;78:151-155.
Objective: The addition of induction chemotherapy (ICT) to concurrent chemoradiation (CCRT) has been investigated as a method of improving outcomes among patients with locally advanced head and neck squamous cell carcinoma. Previous studies have consisted of heterogeneous populations with both p16-positive and p16- negative disease and varying extent of nodal disease burden. We evaluated the role of ICT in p16-positive oropharyngeal squamous cell carcinoma (OPSCC) at high-risk of distant failure.
Materials and methods: A retrospective review was conducted of 88 consecutive patients with p16-positive OPSCC with low-neck and/or N3 lymphadenopathy. Among these patients, 44 received ICT followed by CCRT, and 44 received CCRT alone with concurrent agents including Cisplatin, Carboplatin, and Cetuximab. Disease control and survival outcomes were reported after adjusting for age, T stage, N stage, and smoking status.
Results: Median follow-up for surviving patients was 47 (range: 13–115) months. Patients who received CCRT alone were older than those who received ICT (61 years vs. 56 years; p=0.02); the groups were otherwise similarly balanced. 3-year distant metastasis: 38% vs. 18% (adjusted hazard ratio (HR)=0.32 [0.13–0.82]; p=0.02). 3-year progression-free survival: 49% vs. 74% (adjusted HR=0.46 [0.22–0.93]; p=0.03). 3-year overall survival: 67% vs. 83% (adjusted HR=0.48 [0.21–1.12]; p=0.09).
Conclusion: Among patients with p16-positive OPSCC with low-neck and/or N3 lymphadenopathy, ICT followed by CCRT may reduce the risk for distant failure over CCRT alone and lead to improved progression-free survival. Future trials should concentrate on patients at the highest risk of distant metastasis in order to appropriately assess the benefit of ICT.
PubMed ID: 29496043
Article Size: <1 MB
 

Sinonasal Tract Solitary Fibrous Tumor: A Clinicopathologic Study of Six Cases with a Comprehensive Review of the Literature.

Head & Neck, Sinonasal Tract
Thompson LDR, Lau SK.
Head Neck Pathol. 2018 Dec;12(4):471-480.
Solitary fibrous tumors (SFTs) are well recognized in the head and neck region, but rarely arise in the sinonasal tract (SNT). Six primary SNT SFTs were identified in the files of Southern California Permanente Medical Group between 2006 and 2017. The patients included five males and one female ranging in age from 33 to 72 years (mean 52 years), most of whom presented clinically with nasal obstruction. Three tumors involved the nasal cavity alone, one involved the paranasal sinuses, and two involved both the nasal cavity and paranasal sinuses. Histologically, the tumors were characterized by a variably cellular proliferation of cytologically bland spindle cells within a collagenous stroma with prominent interspersed branching vessels. Mitotic activity was low (range 0–2 per 10 high power fields) and there was no evidence of pleomorphism or tumor necrosis. Surface ulceration was noted. By immunohistochemistry, the lesional cells were positive for CD34, STAT6 and bcl-2. Clinical follow up information was available for all patients (range 32–102 months; mean 72 months). There were no recurrences or metastases and all were alive with no evidence of disease at last follow-up. SFTs rarely affect the SNT, but should be considered in the differential diagnosis of SNT mesenchymal lesions. Immunohistochemical expression of STAT6 can aid in diagnosis and separation of SFT from other spindle cell lesions occurring at this anatomic site. In combination with cases reported in the literature, primary SNT SFT behave in an indolent manner with conservative treatment.
PubMed ID: 29282671
Article Size: 4 MB

Epithelial-Myoepithelial Carcinoma: Frequent Morphologic and Molecular Evidence of Preexisting Pleomorphic Adenoma, Common HRAS Mutations in PLAG1-intact and HMGA2-intact Cases, and Occasional TP53, FBXW7, and SMARCB1 Alterations in High-grade Cases.

Head & Neck, Salivary Gland
El Hallani S, Udager AM, Bell D, Fonseca I, Thompson LDR, Assaad A, Agaimy A, Luvison AM, Miller C, Seethala RR, Chiosea S.
Am J Surg Pathol. 2018 Jan;42(1):18-27.
We hypothesized that there is a relationship between the preexisting pleomorphic adenoma [PA]), histologic grade of epithelial-myoepithelial carcinomas (EMCAs), and genetic alterations. EMCAs (n=39) were analyzed for morphologic and molecular evidence of preexisting PA (PLAG1, HMGA2 status by fluorescence in situ hybridization, FISH, and FGFR1-PLAG1 fusion by next-generation sequencing, NGS). Twenty-three EMCAs were further analyzed by NGS for mutations and copy number variation in 50 cancer-related genes. On the basis of combined morphologic and molecular evidence of PA, the following subsets of EMCA emerged: (a) EMCAs with morphologic evidence of preexisting PA, but intact PLAG1 and HMGA2 (12/39, 31%), (b) Carcinomas with PLAG1 alterations (9/39, 23%), or (c) HMGA2 alterations (10/39, 26%), and (d) de novo carcinomas, without morphologic or molecular evidence of PA (8/39, 21%). Twelve high-grade EMCAs (12/39, 31%) occurred across all subsets. The median disease-free survival was 80 months (95% confidence interval, 77-84 mo). Disease-free survival and other clinicopathologic parameters did not differ by the above defined subsets. HRAS mutations were more common in EMCAs with intact PLAG1 and HMGA2 (7/9 vs. 1/14, P<0.001). Other genetic abnormalities (TP53 [n=2], FBXW7 [n=1], SMARCB1 deletion [n=1]) were seen only in high-grade EMCAs with intact PLAG1 and HMGA2. We conclude that most EMCAs arose ex PA (31/39, 80%) and the genetic profile of EMCA varies with the absence or presence of preexisting PA and its cytogenetic signature. Progression to higher grade EMCA with intact PLAG1 and HMGA2 correlates with the presence of TP53, FBXW7 mutations, or SMARCB1 deletion.
PubMed ID: 29135520
Article Size: 1.2 MB
 

Sinonasal Leiomyosarcoma: Clinicopathological Analysis of Nine Cases with Emphasis on Common Association with Other Malignancies and Late Distant Metastasis.

Head & Neck, Sinonasal Tract
Agaimy A, Semrau S, Koch M, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):463-470.
Sinonasal tract (SNT) leiomyosarcoma (LMS) is exceedingly rare with < 100 cases reported. Their relationship to retinoblastoma and other malignancies, along with previous irradiation has not been clarified. Routine and consultation cases were reviewed for histologically and immunohistochemically proven SNT LMS. The tumors were tested with antibodies against α-smooth muscle actin, desmin, h-caldesmon, HMB45, S100 protein, Rb1, MDM2, CDK4 and EBV (EBER-ISH). Nine tumors affecting 5 males and 4 females aged 26 to 77 years (median: 48 years) were identified in the maxillary sinus (n = 4), nasal cavity (n = 3) and combined SNT (n = 2). Three patients had previous irradiation (2 for retinoblastoma, 1 for fibrous dysplasia) and 1 patient had chemotherapy and stem cell transplantation for Hodgkin lymphoma. One patient had prostatic adenocarcinoma (prior) and rectal adenocarcinoma (post) to the LMS. All patients with follow-up developed either local recurrences and/or metastases, principally to lung (time to metastasis: 16-156 months, mean 62 months). Histologically, 6 tumors were conventional high-grade LMS, two had glycogen-rich clear cell (PEComa-like) morphology and one was spindle cell low-grade. The latter showed grade 2 in the recurrence and grade 3 in the lung metastases. Two cases showed dedifferentiation to anaplastic pleomorphic (inflammatory MFH-like) phenotype. Immunohistochemistry revealed diffuse expression of at least 2 smooth muscle markers in 8 and only actin in one case/s. All other markers were negative. RB1 loss was observed in 6/8 cases tested. Sinonasal tract leiomyosarcomas are rare aggressive sarcomas that frequently develop in a background of previous cancer therapy (4/9), most frequently irradiation. Their varied morphology underlines the wide differential diagnostic considerations. Long-term survival may be achieved with aggressive multimodal therapy.
PubMed ID: 29270859
Article Size: 2.2 MB
 
 
 
 

Nasopharyngeal papillary adenocarcinoma.

Head & Neck, Sinonasal Tract
Thompson LD.
Ear Nose Throat J. 2017 Dec;96(12):456-457.
FIRST PARAGRAPH: The most common malignancy of the nasopharynx is nasopharyngeal carcinoma. However, nasopharyngeal papillary adenocarcinoma is a rare primary tumor of this location. This tumor shows a remarkable papillary architecture, arising from the surface epithelium and in general showing indolent biologic behavior. There are no known etiologic agents, lacking any Epstein Barr virus or human papillomavirus association.
PubMed ID: 29236265
Article Size: <1 MB

Localized Nasopharyngeal Amyloidosis: A Clinicopathologic Series of 7 Cases with a Literature Review

Head & Neck, Sinonasal Tract
Sakagiannis G, Giotakis E, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):542-547.
Localized nasopharyngeal amyloidosis is an extremely rare entity with only 25 cases described in the English and German literature. We present a case series of seven patients with localized nasopharyngeal amyloidosis and combine the findings with a thorough review the literature.
PubMed ID: 29282670
Article Size: 1.2 MB
 

Pathologic reporting of Tall Cell Variant of Papillary Thyroid Cancer: Have we reached a consensus?

Endocrine, Thyroid
Hernandez-Prera J, Machado R, Asa SL, Baloch ZW, Faquin WC, Ghossein R Md, LiVolsi VA, Lloyd RV, Mete O, Nikiforov YE, Seethala R, Suster S, Thompson LDR, Turk A, Sadow PM, Urken ML, Wenig BM.
Thyroid. 2017 Dec;27(12):1498-1504.
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 interobserver variability. We aim to determine the level of agreement among expert pathologists in the identification and reporting of TCV.
METHODS: 17 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. Fifteen out of twenty-two (68%) cases originally diagnosed as PTC classical variant were re-classified 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.
PubMed ID: 29020884
Article Size: <1 MB
 

Noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a review for pathologists.

Endocrine, Thyroid
Seethala RR, Baloch ZW, Barletta JA, Khanafshar E, Mete O, Sadow PM, LiVolsi VA, Nikiforov YE, Tallini G, Thompson LD.
Mod Pathol. 2018 Jan;31(1):39-55.
The rising incidence of papillary thyroid carcinoma is linked in part to inclusion of noninvasive follicular variant of papillary thyroid carcinoma. Despite its designation as carcinoma, noninvasive follicular variant of papillary thyroid carcinoma appears to be exceptionally indolent, often over treated by current treatment practices. Additionally, criteria for diagnosis have historically been subjective and challenging. Recently, an international multidisciplinary collaborative group performed a clinicopathologic survey of such cases with extended follow-up and concluded based on the outcome data that a revision in nomenclature was warranted, proposing ‘Noninvasive Follicular Thyroid Neoplasm with Papillary-like Nuclear Features (NIFTP).’ This monograph is a synopsis and guide for pathologists on NIFTP and focuses on histologic features, including inclusion and exclusion criteria used to define NIFTP, as well as grossing guidelines, reporting practices, and potential diagnostic limitations.
PubMed ID: 29052599
Article Size: 1.5 MB
 
 
 
 

Long-term follow-up of a patient with malignant transformation of inverted papilloma into sinonasal undifferentiated carcinoma.

Head & Neck, Sinonasal Tract
Orgain CA, Shibuya TY, Thompson LD, Keschner DB, Garg R, Lee JT.
Allergy Rhinol (Providence). 2017 Oct 1;8(3):173-177.
INTRODUCTION: Inverted papillomas (IP) are benign sinonasal neoplasms, which account for 0.5-4% of all nasal tumors. IPs have been known to transform into squamous cell carcinoma in 5-15% of cases. Rarely, transformations to other malignancies have been reported. Here we report a unique case of malignant transformation of an IP into sinonasal undifferentiated carcinoma (SNUC).
METHODS: A case report with a literature review; institutional review board exempted. The clinical presentation, radiographic features, surgical intervention, histopathologic analysis, treatment, and outcome of the case were examined.
RESULTS: A 62-year-old man presented with a 3-month history of nasal airway obstruction, rhinorrhea, and postnasal drip refractory to medical therapy. He had a long history of exposure to fumes, chemicals, dusts, and solvents as a professional painter as well as a 45 pack-year history of smoking and alcohol abuse. The patient was ultimately found to have a left ethmoidal IP with a focus of malignant transformation into SNUC. Endoscopic resection was performed, followed by concurrent chemoradiation and adjuvant chemotherapy. After surgery, he had no evidence of recurrent disease after 9 years of follow-up.
CONCLUSIONS: IP is known to transform into squamous cell carcinoma. Here we report a rare case of malignant transformation into SNUC, a much more uncommon and aggressive lesion. Although traditionally associated with a poorer prognosis, the positive outcome for SNUC observed in this patient may potentially be attributed to early detection and timely therapeutic intervention.
PubMed ID: 29070275
Article Size: 1 MB
 

Ear fetal rhabdomyoma.

Ear & Temporal Bone, Head & Neck
Thompson LD.
Ear Nose Throat J. 2017 Sep;96(9):358.
FIRST PARAGRAPH: Rhabdomyomas are a group of benign tumors that show skeletal muscle differentiation. They are divided into cardiac and extracardiac types with the extracardiac type divided into adult, fetal, and genital types. The fetal type is separated into myxoid and intermediate types. There is a predominance in the head and neck of both the fetal and adult types. The fetal type is commonly seen in newborns and early childhood, with a moderate male predominance (2:1).
PubMed ID: 28931187
Article Size: <1 MB

Improving margin revision: Characterization of tumor bed margins in early oral tongue cancer.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Prabhu AV, Sturgis CD, Lai C, Maxwell JH, Merzianu M, Hernandez-Prera JC, Purgina B, Thompson LDR, Tuluc M, Yang X, Seethala RR, Ferris RL, Chiosea SI.
Oral Oncol. 2017 Dec;75:184-188.
OBJECTIVES: To improve margin revision, this study characterizes the number, fragmentation, and orientation of tumor bed margins (TBM) in patients with pT1-2 pN0 squamous cell carcinoma (SCC) of the oral tongue.
MATERIALS AND METHODS: Pathology reports (n=346) were reviewed. TBM parameters were indexed. In Group 1 patients all margins were obtained from the glossectomy specimen and there were no TBM. In Revision Group/Group 2 (n=103), tumor bed was sampled to revise suboptimal margins identified by examination of the glossectomy specimen. In Group 3 (n=124), TBM were obtained before examination of the glossectomy specimen.
RESULTS AND CONCLUSIONS: Fewer TBMs were obtained per patient in Group 2 compared to Group 3 (57/103, 55% of patients with <3 vs. 117/124, 94%, ≥3 TBMs, respectively). The new margin surface was more frequently indicated in Group 2 compared to Group 3 (59/103, 57%, vs. 19/124, 15%, p<.001). If glossectomy specimen margins are accepted as the reference standard, then the TBM was 15% sensitive in Group 2 (95% confidence interval [CI], 7-29) and 32% sensitive in Group 3 (95% CI, 15-55). TBM fragmentation (23/103, 22% vs. 42/124, 34%) and frozen vs. permanent discrepancies (8/103, 3% vs. 3/124, 2%) were similar between Groups 2 and 3. The new margin surface was not indicated in 6 of 11 cases with discrepant frozen vs. permanent pathology findings, precluding judgment on final margin status. To facilitate the assessment of final margins, TBM should be represented by one tissue fragment with a marked new margin surface.
PubMed ID: 29074194
Article Size: <1 MB
 
 
 
 

Sinonasal Tract Alveolar Rhabdomyosarcoma in Adults: A Clinicopathologic and Immunophenotypic Study of Fifty-Two Cases with Emphasis on Epithelial Immunoreactivity.

Head & Neck, Sinonasal Tract
Thompson LDR, Jo VY, Agaimy A, Llombart-Bosch A, Morales GN, Machado I, Flucke U, Wakely PE Jr, Miettinen M, Bishop JA.
Head Neck Pathol. 2018 Jun;12(2):181-192.
Sinonasal tract (SNT) alveolar rhabdomyosarcoma (ARMS) are frequently misdiagnosed, especially in adults. Fifty-two adult (≥18 years) patients with SNT ARMS were reviewed and characterized by immunohistochemistry and molecular studies. Twenty-six females and 26 males (18-72 years; mean 43.2 years), presented after a short duration (mean 2.6 months) with a large (mean 5.5 cm) destructive nasal cavity mass, involving multiple contiguous paranasal sites (n = 46) and with cervical adenopathy (n = 41). The tumors showed an alveolar, nested to solid growth pattern below an intact, but often involved (n = 9) epithelium with frequent necrosis (n = 37), destructive bone invasion (n = 30), and lymphovascular invasion (n = 25). The neoplastic cells were dyshesive and dilapidated, with crush artifacts. Rhabdoid features (n = 36) and tumor cell multinucleation (n = 28) were common. Mitotic counts were high (mean 17/10 HPFs). The neoplastic cells showed the following immunohistochemical positive findings: desmin (100%), myogenin (100%), MYOD1 (100%), MSA (96%), SMA (52%), CAM5.2 (50%), AE1/AE3 (36%); other positive markers included S100 protein (27%), CD56 (100%), synaptophysin (35%), and chromogranin (13%). Overall, 54% show epithelial marker reactivity. Molecular studies showed FOXO1 translocations (81%) with PCR demonstrating PAX3 in 72.7% tested. Patients presented with high stage (IV 24; III 26) and metastatic disease (lymph nodes n = 41; distant metastases n = 25) (IRSG grouping). Surgery (n = 16), radiation (n = 41) and chemotherapy (n = 45) yielded an overall survival of 36.1 months (mean; range 2.4-286); 18 alive without disease (mean 69.6 months); 7 alive with disease (mean 11.0 months); 1 dead without disease (63.7 months); and 26 dead with disease (mean 18.5 months). SNT ARMS frequently present in adults as a large, destructive midline mass of short symptom duration, with high stage disease. The alveolar to solid pattern of growth of cells with rhabdoid-plasmacytoid features suggests the diagnosis, but epithelial immunohistochemistry markers are present in 54% of cases, leading to misdiagnosis as carcinomas if muscle markers are not also performed. Overall survival of 36.1 months is achieved with multimodality therapy, but 64% have incurable disease (16.9 months). Mixed anatomic site (p = 0.02) was a significant adverse prognostic indicator, while stage (0.06) and tumor size >5 cm (0.06) approached marginal significance.
PubMed ID: 28875443
Article Size: 4 MB
 
 
 
 

Metastases to the Parathyroid Glands: A Comprehensive Literature Review of 127 Reported Cases.

Endocrine, Parathyroid
Bauer JL, Toluie S, Thompson LDR.
Head Neck Pathol. 2018 Dec;12(4):534-541.
Metastases to the head and neck organs are uncommon, potentially representing the initial presentation of an occult malignancy. Single case reports and small series report metastases to the parathyroid gland, but there is no large review of the literature on secondary tumors involving the parathyroid glands. A review of the English literature between 1950 and 2017 was performed of all metastases or secondary involvement of the parathyroid glands. One hundred and twenty-seven cases of metastatic tumors were reported, although potentially significantly unrepresented in autopsy series (parathyroid glands are not routinely examined) and due to reporting bias. Women were affected more commonly than men (5.8:1; 99 vs. 17, respectively), with a mean age at presentation of 58.5 years, when reported. The most common primary sites of malignancies that metastasized to the parathyroid glands were breast carcinomas (66.9%, n = 85), melanoma (11.8%, n = 15), and lung carcinoma (5.5%, n = 7), with carcinomas representing 86.6% of metastases. Metastases were nearly always identified as part of widely metastatic disease, with only five (3.2%) cases reported as isolated metastases. Tumor-to-tumor metastases comprised 5.5% of all metastases to the parathyroid glands (metastases to parathyroid adenoma). A significant clinical finding of metastases to the parathyroid glands was the development of deranged calcium homeostasis, well beyond the 9 (7.2%) cases with primary parathyroid gland disease present. Although concurrent conditions (renal disease; bone metastases) may partially affect calcium metabolism, the onset of calcium derangement seemed to coincide with parathyroid gland metastases and not systemic disease. In summary, metastases to the parathyroid glands are uncommon, potentially under-recognized in patients who have otherwise widely metastatic tumors. Women are affected more often than men, with breast carcinomas (66.9%) and melanoma (11.8%) the most common primary tumors. Calcium homeostasis is affected, probably as a result of parathyroid gland parenchymal destruction.
PubMed ID: 28875280
Article Size: 1.1 MB
 
 
 

Ectopic Hamartomatous Thymoma: A Review Of The Literature With Report Of New Cases And Proposal Of A New Name: Biphenotypic Branchioma.

Head & Neck, Neck
Sato K, Thompson LDR, Miyai K, Kono T, Tsuda H.
Head Neck Pathol. 2018 Jun;12(2):202-209.
Ectopic hamartomatous thymoma (EHT) is a rare benign neoplasm of the lower neck suggesting branchial origin. Despite use of the term thymoma in the nomenclature, there is no evidence of thymic origin or differentiation. It affects middle-aged adults with a remarkable male predominance. To date less than 80 cases have been reported in the English literature. We present here two additional cases of EHT. The first is a benign case in a 31-year-old man, showing typical histological features. The second is a malignant case in a 70-year-old woman, showing intraductal carcinoma arising in intimate association with an EHT. These cases are presented in the context of a review of cases reported in the English literature. The exact origin has not been identified, but is considered to be of branchial apparatus, creating a quandary about the best terminology. Recently, the designation “branchial anlage mixed tumor” or “thymic anlage tumor” were proposed, but do not quite reflect the true nature of the neoplasm. To avoid taxonomic confusion, international consensus on terminology is desired. As this entity is a neoplasm that shows dual mesoderm and endoderm derivation/differentiation, we propose a new name “biphenotypic branchioma.”
PubMed ID: 28879635
Article Size: 2 MB
 
 
 
 

Lobular capillary hemangioma (pyogenic granuloma) of the oral cavity.

Head & Neck, Oral Cavity/Gnathic (Jaw)
Thompson LD.
Ear Nose Throat J. 2017 Jul;96(7):240.
FIRST PARAGRAPH: Lobular capillary hemangioma (LCH), sometimes also called pyogenic granuloma or epulis gravidarum, is a benign overgrowth of capillaries showing a vascular phenotype. There are several etiologic factors, including hormones (increased in pregnancy and in patients using oral contraceptives), localized trauma (biting, fractured tooth, poor restorations), and when there is poor oral hygiene.
PubMed ID: 28719705
Article Size: <1 MB

AFIP Atlas: Tumors of the Salivary Glands (Fifth Series, Vol. 5)

Books
AFIP Atlas: Tumors of the Salivary Glands

Justin A. Bishop, MD • Lester D.R. Thompson, MD • Paul E. Wakely, Jr., MD • Ilan Weinreb, MD

Information:

  • Hardcover: 719 pages
  • Publisher: ARP Press; 1st edition (2021)
  • Language: English
  • ISBN-10: 1-933477-94-6
  • ISBN-13: 978-1-933477-94-7
  • Product Dimensions: approx. 8.75 x 1.375 x 11 inches

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Publisher’s description:

This book serves as a one-stop, comprehensive reference for the pathology of salivary gland neoplasms, with an emphasis on numerous high-quality, illustrative photomicrographs. The authors incorporated the most cutting-edge genetic data emerging on such tumors, as this information often has a profound impact on their diagnosis and classification. With the quickly evolving nature of salivary gland pathology, this contribution to the Fifth Series is a key update to the previous edition from the Fourth Series, which was published in 2008.

Non-Neoplastic Diseases of the Head and Neck, (1st series, Vol. 11)

Books
AFIP Atlas of Nontumor Pathology: Non-Neoplastic Diseases of the Head and Neck

Bruce M. Wenig, MD • Esther L. B. Childers, MD • Mary S. Richardson, MD • Raja R. Seethala, MD • Lester D.R. Thompson, MD

Information:

  • Hardcover: 491 pages
  • Publisher: ARP Press; 1st edition (2017)
  • Language: English
  • ISBN-10: 1-9334-77-37-7
  • ISBN-13: 978-1-933477-37-4
  • Product Dimensions: approx. 8.75 x 1.125 x 11 inches

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Nasopharyngeal Angiofibroma: A Clinical, Histopathological and Immunohistochemical Study of 42 Cases with Emphasis on Stromal Features.

Head & Neck, Sinonasal Tract
Sánchez-Romero C, Carlos R, Díaz Molina JP, Thompson LDR, de Almeida OP, Rumayor Piña A.
Head Neck Pathol. 2018 Mar;12(1):52-61.
Nasopharyngeal angiofibroma is a benign but aggressive tumor of unknown etiology, typically occurring in adolescent males. It is described as a rare neoplasm; however, the prevalence seems to have geographic differences. All cases referred to our head and neck clinical and pathology service were reviewed. Most of the patients presented at an advanced stage. The clinical and radiographic features are presented and discussed. Histologically, the tumor shows a highly vascular fibrous proliferation with characteristic plump, angulated and stellate cells, categorized as fibroblasts. Immunohistochemistry was performed on 42 cases to further elucidate the nature of these cells. The stromal cells expressed vimentin and factor XIIIa, the latter expressed most commonly in the giant stellate cells. Inflammation was almost exclusively present in peripheral subepithelial areas. Mast cells were abundant, even in the absence of other inflammatory cells. Lymphatics were observed principally in peripheral regions. Proliferating cells (Ki-67 reactive) were restricted to endothelial cells.
PubMed ID: 28508272
Article Size: 3 MB