Ackerman's Surgical Pathology Research Articles

B CELL LYMPHOMA PRESENTING AS A CYSTIC LUNG DISEASE

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Cystic lung airspaces can be seen in a multitude of diseases including lymphangioleiomyomatosis, Langerhan cell histiocytosis, Birt-Hogg-Dube syndrome, cystic metastases, or even postinfectious pneumatoceles. Lymphoma, however, is not often included in the differential diagnosis. We describe a rare presentation of B cell lymphoma presenting as a cystic lung disease. CASE PRESENTATION: Forty five year old female with a past medical history of diabetes mellitus and hypertension was originally referred to us for a lung biopsy. Patient had worsening shortness of breath for 1 year. She had a computed tomography of the chest at another facility which showed extensive cystic spaces in the lungs, suspicious for lymphangiomyomatosis. Patient was evaluated by a pulmonologist as an outpatient and had a bronchoscopy with biopsy. After receiving inconclusive results, she was given a course of antibiotics and had relief of her symptoms for some time. Months later the patient had an episode of severe coughing which prompted a visit to a hospital within our system where she had another computed tomography of the chest with contrast revealing the same diffuse cystic disease that was worse at the bases. She was subsequently referred to us and underwent video-assisted thoracic surgery with right upper, middle, and lower lobe biopsies. Pathology of the right middle lobe was revealed diffuse large B-cell lymphoma. Cystic change was seen in all of the biopsies. DISCUSSION: Lymphoma is one of the great masqueraders in medicine. Because of this, it should be included in the differential diagnosis for patients such as this with multiple cystic airspaces. Primary pulmonary extranodal lymphomas are rare, accounting for 0.4% of all lymphomas, and only 15-20% of these are high grade. These lymphomas are usually either mucosa-associated (MALT) or bronchus-associated lymphoid tissue (BALT) lymphomas. Presentations vary but are most often found as solitary nodules or masses and may be found incidentally. With more diffuse disease, other symptoms like shortness of breath, cough, chest pain, or even hemoptysis may arise. There is an association between immunosuppression and pulmonary lymphomas, as well with human immunodeficiency virus (HIV) infection and inflammatory conditions like rheumatoid arthritis and Sjogren disease. Diagnosis requires surgical biopsy because a bronchoalveolar lavage or fine needle biopsy may show lymphoma cell infiltration but cannot exclude other differential diagnoses such as reactive lymphoid proliferation, or lymphoid interstitial pneumonia. CONCLUSIONS: Lymphoma is one of the great masqueraders in medicine and can present in many different ways. Because of this, it should be included in the differential diagnosis in patients such as this with multiple cystic airspaces of the lungs. Diagnosis requires a surgical biopsy which should be included in these cases. REFERENCE #1: Girard, N., & Cadranel, J. (n.d.). Rare Primary Lung Tumors. In Murray and Nadel's Textbook of Respiratory Medicine (6th ed., pp. 965-980). Elsevier. REFERENCE #2: Hagga, John. "Nonneoplastic Parenchymal Lung Disease." CT and MRI of the whole body, 6th ed., Elsevier, 2017, pp. 928–983. REFERENCE #3: Myers, J. L. (2018). Lung. In Rosai and Ackerman's Surgical Pathology (11th ed., pp. 372-443). Elsevier. DISCLOSURES: no disclosure on file for Bishoy Hanna; No relevant relationships by Diego Marin, source=Web Response no disclosure on file for Christina Migliore Patel; no disclosure on file for Xinlai Sun

Benign disease prone to be misdiagnosed as malignant pulmonary nodules: Minute meningothelioid nodules.

BackgroundThe lung is one of the most common target organs for malignant tumor metastasis. The existence of lung metastasis may have a decisive effect on the choice of treatment regimen. Minute pulmonary meningothelial‐like nodules (MPMNs) usually present as ground‐glass opacity or solid nodules, mimicking the imaging findings of malignant pulmonary nodules. This study summarizes the clinical, radiological, and pathological features of MPMNs to distinguish them from malignant pulmonary nodules.MethodsThe Guangdong Lung Cancer Institute Pathology Information System was searched using the key words “minute meningothelioid nodules” and “lung.” Patients who underwent pulmonary resection from 23 February 2009 to 31 May 2017 were included in the study. The 11th edition of Rosai and Ackerman's Surgical Pathology was used to confirm the diagnosis. The clinical, imaging, and pathological characteristics of MPMNs were recorded.ResultsTwelve patients had MPMNs. MPMNs were associated with cancerous or precancerous lesions (10/12), female gender (11/12), and non‐smokers (11/12). Four patients were misdiagnosed with malignant pulmonary nodules before surgery. Positron emission tomography‐computed tomography revealed an increased maximum standardized uptake value in one patient. Immunohistochemistry identified eight specimens positive for vimentin, EMA, and PR and negative for TTF‐1 and CK.ConclusionsMPMNs tend to coexist with malignant tumors, mimicking the imaging findings of malignant pulmonary nodules, thus resulting in misdiagnosis. Dynamic monitoring or an invasive examination may help to distinguish MPMNs from malignant lesions.

Online Teaching and Assessment Modules for Rotations in Surgical Pathology

OPEN ACCESSAugust 16, 2012Online Teaching and Assessment Modules for Rotations in Surgical Pathology Bronwyn Bryant, MD, Amanda Maskovyak, MD, Linda M. Schiffhauer, MD, Ronald Bryant, MD, Wenqing Cao, BM, MS, MD, P. Anthony di Sant'Agnese, MD, Christa L. Whitney-Miller, MD, Haodong Xu, BM, PhD Bronwyn Bryant, MD University of Washington School of Medicine Google Scholar More articles by this author , Amanda Maskovyak, MD Cleveland Clinic Google Scholar More articles by this author , Linda M. Schiffhauer, MD University of Rochester Google Scholar More articles by this author , Ronald Bryant, MD University of Vermont Google Scholar More articles by this author , Wenqing Cao, BM, MS, MD University of Rochester Google Scholar More articles by this author , P. Anthony di Sant'Agnese, MD University of Rochester Google Scholar More articles by this author , Christa L. Whitney-Miller, MD University of Rochester Google Scholar More articles by this author , Haodong Xu, BM, PhD University of Rochester Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.9216 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThese multimedia modules have been developed to teach senior medical students on their surgical pathology elective the basic microscopic features of common surgical pathology diagnoses. The modules include normal histology and pathology organized into the following organ systems: breast, gastrointestinal, genitourinary, gynecologic, liver, and lung. The first component to this teaching set is a review of normal histology which may serve as a comparison for the histopathology component. A low- and high-power micrograph of each organ is provided. The student is tested with a quiz of micrographs of normal histology where they must identify the organ. Next, students review commonly encountered biopsies in each organ system. Under each diagnosis is listed the definition, etiology, symptoms/indications for biopsy, gross features, microscopic features, and a differential diagnosis. Radiologic features and pertinent additional stains are noted when appropriate. The goal of the surgical pathology rotation at this institution is to allow students to function as junior house officers, actively participating in previewing and sign-out. These teaching modules will provide basic clinical and microscopic descriptions to help the student preview and diagnose biopsy specimens on their own. The clinical implications of certain diagnoses as they pertain to aggressive management in neoplastic disease will also be mentioned. The modules are designed so students can easily navigate between slides, diagnoses, and differentials. Each image is provided with arrows and labels (which may be hidden) to guide the eye of the learner to recognize the patterns of each diagnosis. After completing a module, students will solidify their knowledge with a quiz. We plan to monitor the effectiveness of this assessment by having students take the quiz at the start and end of the rotation to compare the change in their score. These modules will provide an organized foundation on which the student may build his or her knowledge during slide review with senior residents or staff pathologists. Educational Objectives By the end of the module, learners will be able to: Identify commonly biopsied organs microscopically.Formulate a diagnosis from micrographs of commonly biopsied organs.Discuss the pertinent clinical, pathologic, and microscopic features of common pathologic diagnoses. ReferencesAmin M. (2010) “Diagnostic Pathology: Genitourinay.” Amirsys: Salt Lake City, UT.Google ScholarGreenson J et. al. (2009) “Diagnostic Pathology: Gastrointestinal.” Amirsys: Salt Lake City, UT.Google ScholarHicks D. and Lester S.. (2011) “Diagnostic Pathology: Breast” Amirsys: Salt Lake City, UT.Google ScholarKumar V et al. (2009) “Robbins & Cotran Pathologic Basis of Disease.” Saunders; 8th edition.Google ScholarOdze RD and Goldblum JR. (2009) “Surgical Pathology of the GI tract, liver, biliary tract, and pancrease.” Saunders: Philadelphia, PA.Google ScholarPernick N. (2001, August). Pathology outlines. Retrieved January/February 2011, from http://PathologyOutlines.comGoogle ScholarRosai Juan. (2010) “Rosai and Ackerman's Surgical Pathology.” Mosby; 10th edition.Google Scholar Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Instructors Guide.doc Online Teaching Assessment To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationBryant B, Maskovyak A, Schiffhauer LM, Bryant R, Cao W, di Sant'Agnese PA, Whitney-Miller CL, Xu H. Online Teaching and Assessment Modules for Rotations in Surgical Pathology. MedEdPORTAL. 2012;8:9216. https://doi.org/10.15766/mep_2374-8265.9216 Copyright & Permissions© 2012 Bryant et al. This is an open-access publication distributed under the terms of the Creative Commons Attribution-NonCommercial license.KeywordsGynecologicGenitourinaryBiopsied OrgansLiverBiopsyMicrographsPathologic DiseasesLungBreast Disclosures None to report. Funding/Support None to report. Loading ...

Rosai and Ackerman's Surgical Pathology Review

Rosai and Ackerman's Surgical Pathology Review

Book Review: Rosai and Ackerman's Surgical Pathology Review

Book Review: Rosai and Ackerman's Surgical Pathology Review

Rosai and Ackerman's Surgical Pathology Review

Advances in Anatomic Pathology: September 2008 - Volume 15 - Issue 5 - p 308 doi: 10.1097/PAP.0b013e31818322fb

Essentials of Anatomic Pathology

For a physician training or practising in histopathology (or anatomic pathology in the US) a good general text to which most problems generated by the daily reporting workload can be referred is essential. This role is filled, admirably so for most of us, by some of the monoliths of the subject, the best known of which is probably Rosai and Ackerman's Surgical Pathology; a copy this weighty tome must, I would think, reside in almost every reporting room in the world. It is such a role that the recently published second edition of Essentials of Anatomic Pathology also aims to fill, in the words of its preface ‘an up-to-date handbook that contains relevant information to establish an accurate diagnosis’ which is ‘organised to allow easy reference for daily practice’.

Rosai and Ackerman's surgical pathology, 9th edition author: Juan Rosai Mosby, Edinburgh, 2004

Rosai and Ackerman's surgical pathology, 9th edition author: Juan Rosai Mosby, Edinburgh, 2004

The Transition of the Concept of Gastrointestinal Stromal Tumor (GIST)

Gastrointestinal stromal tumor (GIST) is generally defined as a mesenchymal tumor that consisits of spindle-shaped or epitheloid cells, originates in the gastrointestinal tract, and immunohistochemically expresses c-kit and/or CD34, regardless of myogenic and neurogenic markers. Gastrointestinal mesenchymal tumors are generally diagnosed as the submucosal tumors. Most of these tumors were histologically diagnosed as myogenic or neurogenic tumors. However, with the development of immunohistochemistry in the 1980s, we were able to clearly distinguish between myogenic tumors and neurogenic tumors. This new ability also resulted in the development of a new concept of the tumor that could not be classified into either of them. The tumor is, in fact, GIST. However, a quarter of a century was required for the concept and the treatment of GIST to be established. Because of four breakthroughs (1. the development of immunohistochemistry, 2. the classification in Ackerman's Surgical Pathology, 3. the derivation from interstitial cells of Cajal and 4. the high efficacy of imatinib mesylate) during this time, the concept of GIST has changed greatly. On the other hand, the resistance to imatinib in GIST has gradually increased, and new problems have arisen. The further development of drugs (five kinds of drugs such as SU 11248 are undergoing clinical trials) is awaited.

Ackerman's surgical pathology volumes I and II. Juan Rosai. Sixth edition. 258 × 185 mm. Pp. Vol. I: 1122 + xii, Vol. II: 1835 + xii. Illustrated. 1981. London: Year Book. £85·00

Ackerman's surgical pathology volumes I and II. Juan Rosai. Sixth edition. 258 × 185 mm. Pp. Vol. I: 1122 + xii, Vol. II: 1835 + xii. Illustrated. 1981. London: Year Book. £85·00 Get access Ackerman's Surgical Pathology Volumes I and II. Juan Rosai. Sixth edition. 258 × 185 mm. Pp. Vol. I: 1122 + xii, Vol. II: 1835 + xii. Illustrated. 1981. London: Year Book. £85·00. Brendan Devlin Brendan Devlin Search for other works by this author on: Oxford Academic Google Scholar British Journal of Surgery, Volume 69, Issue 4, April 1982, Page 239, https://doi.org/10.1002/bjs.1800690432 Published: 07 December 2005

Rosai and Ackerman's Surgical Pathology, 9th ed. Edited by Juan Rosai. St. Louis, MO: Mosby, 3,080 pp., 2004. $349

Rosai and Ackerman's Surgical Pathology, 9th ed. Edited by Juan Rosai. St. Louis, MO: Mosby, 3,080 pp., 2004. $349

Rosai and Ackerman's Surgical Pathology

Rosai and Ackerman's Surgical Pathology

Percutaneous embolization of mandibular hemangioma: A case report

Hemangiomas are benign vascular endothelial tumors, and when they occur in bone they replace the bone marrow. 1 Rosai J Ackerman's Surgical Pathology. in: ed 8. Mosby, St Louis, MO1996: 1966 Google Scholar Hemangiomas account for 0.7% of primary bone tumors, and they occur in about 10% of neonatal infants, with a significant female predominance (5:1). 2 Connors III, JJ Wojak JC Interventional Neuroradiology. in: ed 1. Saunders, Philadelphia, PA2000: 338 Google Scholar In the head and neck region, hemangiomas involve mostly the skull and spine; about 10% involve the mandible. 3 Som PM Head and Neck Imaging. in: ed 2. Mosby, St Louis MO1975: 398 Google Scholar About 80% grow during the first year of life only to regress before the age of 5. The therapy for this group is observation until total regression. The other 20% remain highly vascular and continue to slowly grow, often resulting in complications due to the compression and/or obstruction of contiguous structures. Symptomatic hemangiomas in other parts of the body like the spine have been successfully embolized percutaneously in the past. 4 Jayakumar PN Vasudev MK Srikanth SG Symptomatic vertebral haemangioma-endovascular treatment: Study of 7 cases. Spinal cord. 1997; 35: 624 Crossref PubMed Scopus (50) Google Scholar We present this case to highlight this technique in the mandibular hemangioma.

4727 Reassessment of usefulness of eus in differentiation of benign and malignant gastric stromal tumors which were diagnosed according to pathologic guidelines of ackerman's surgical pathology.

Backgrounds: GISTs originate from mesenchymal tissue within the GI tract, and it is difficult to differentiate between benign and malignancy by endoscopy. Although recent development of EUS allows a trial of differentiation from benign and malignant stromal tumors, its diagnostic accuracy is controversial. The aim of this study is to determine whether EUS can differentiate between benign and malignant gastric stromal tumors. Materials and Methods: EUS was performed prior to endoscopic resection or surgical resection of 38 gastric stromal tumors. EUS features such as tumor size(diameter>4 cm), irregular extraluminal border, echogenic foci, and cystic spaces, which were proposed by Chak A et al. as EUS findings of malignant GISTs(Gastrointest Endosc 1997) were evaluated. Pathologic diagnosis was based on guidelines of Ackerman's surgical pathology (Ackerman's surgical pathology 8th ed, 1996). Results: Subjects consisted of 12 males and 26 females. 22 cases has been endoscopically resected, 16 cases surgically removed. The results of immunohistochemical staining showed 12 cases of smooth muscle type, 7 cases of neural type, 1 case of mixed type and 18 cases of uncommitted type. On the basis of above immunohistochemical results and histologic findings, 12 cases were regarded as benign, 17 cases as potentially malignant or malignant, and 9 cases as malignant. Analyses of EUS features according to the criteria of Chak et al. are shown in the following table. Conclusion: When gastric stromal tumors were diagnosed with criteria from Ackerman's surgical pathology, EUS features, which were proposed by Chak et al, were assessed to be less useful in differentiating between benign and malignant stromal tumors. Backgrounds: GISTs originate from mesenchymal tissue within the GI tract, and it is difficult to differentiate between benign and malignancy by endoscopy. Although recent development of EUS allows a trial of differentiation from benign and malignant stromal tumors, its diagnostic accuracy is controversial. The aim of this study is to determine whether EUS can differentiate between benign and malignant gastric stromal tumors. Materials and Methods: EUS was performed prior to endoscopic resection or surgical resection of 38 gastric stromal tumors. EUS features such as tumor size(diameter>4 cm), irregular extraluminal border, echogenic foci, and cystic spaces, which were proposed by Chak A et al. as EUS findings of malignant GISTs(Gastrointest Endosc 1997) were evaluated. Pathologic diagnosis was based on guidelines of Ackerman's surgical pathology (Ackerman's surgical pathology 8th ed, 1996). Results: Subjects consisted of 12 males and 26 females. 22 cases has been endoscopically resected, 16 cases surgically removed. The results of immunohistochemical staining showed 12 cases of smooth muscle type, 7 cases of neural type, 1 case of mixed type and 18 cases of uncommitted type. On the basis of above immunohistochemical results and histologic findings, 12 cases were regarded as benign, 17 cases as potentially malignant or malignant, and 9 cases as malignant. Analyses of EUS features according to the criteria of Chak et al. are shown in the following table. Conclusion: When gastric stromal tumors were diagnosed with criteria from Ackerman's surgical pathology, EUS features, which were proposed by Chak et al, were assessed to be less useful in differentiating between benign and malignant stromal tumors.

4728 Classification of gastric stromal tumor according to immunohistochemical phenotype.

Backgrounds: Gastrointestinal stromal tumor(GIST) is a mesenchymal tumor which originates from the GI tracts. Although recent immunohistochemical study has helped classifying mesenchymal tumor and forming diagnostic criteria for benign and malignant tumors according to cell's origin and differentiation, it is yet to be settled. This study has classified gastric stromal tumor by using immunohistochemical staining. Materials and Methods: Immunohistochemical staining was performed on the gastric stromal tumor specimens attained by endoscopic resection and surgery. Smooth muscle actin, Desmin, Neuron-specific enolase, S-100, CD 34 and Vimentin has been used as immunohistochemical antibodies and the guideline for Ackerman's surgical pathology has been used as criteria for diagnosing malignancy(Ackerman's surgical pathology 8th ed, 1996). Smooth muscle type was classified as benign, borderline and malignant according to the size and number of mitosis. Neural type was classified as malignant, and combined smooth muscle-neural type and uncommitted type were classified as either potentially malignant or malignant. Results: Subjects consisted of 12 males and 26 females with average age being 53 ± 12.8 years old. 22 cases has been endoscopically resected, 16 surgically removed, with the mean length of tumor being 25.3 ± 18.1 mm. The results of immunohistochemical staining showed 12 cases(31.6%) of smooth muscle type, 7 cases(18.4%) of neural type, 1 case(2.6%) of combined smooth muscle-neural type and 18 cases(47.4%) of uncommitted type. On the basis of above immunohistochemical results and histologic findings, 12 cases(31.6%) were regarded as benign, 17 cases(44.7%) as potentially malignant or malignant, and 9 cases(23.7%) as malignant(Table). Conclusion: When classified by immunohistochemical staining, 68.4% of gastric stromal tumor proved to be potentially malignant or malignant.

Primary cardiac leiomyosarcoma: imaging with 2-D echocardiography, electron beam CT and 1.5-Tesla MR

Primary cardiac sarcomas are extremely rare [ 1 Rosai J. Cardiovascular system. In: Rosai Juan, editor. Ackerman's Surgical Pathology. 8th edn. St. Louis: Mosby-Year Book, 1996; 2182–2188. Google Scholar ]. There are only a few case reports concerning the sonography, computed tomography (CT) and magnetic resonance imaging (MRI) appearance of cardiac leiomyosarcoma [ 2 Nguyen KT, Mak K, Sanfilippo AJ, Rosen WS, Cheeseman FD. Primary left atrial leiomyosarcoma simulating pulmonary thromboembolism. Can Assoc Radiol J 1994; 45: 48–51. Google Scholar , 3 Antunes MJ, Vanderdonck KM, Andrade CM, Rebelo LS. Primary cardiac leimyosarcoma. Ann Thorac Surg 1991; 51: 999–1001. Google Scholar , 4 Lund JT, Ehman RL, Julsrud PR, Sinak U, Tajik AJ. Cardiac masses: assessment by MR imaging. AJR 1989; 152: 469–473. Google Scholar , 5 Stanford W, Galvin JR, Weiss RM, et al. Ultrafast computed tomography in cardiac imaging: a review. Semin US CT MR 1991; 12: 45–49. Google Scholar ]. In a review of the literature reported by Nguyen et al., only 27 cases (including his own patient) of primary leiomyosarcoma of the heart had been reported [ 2 Nguyen KT, Mak K, Sanfilippo AJ, Rosen WS, Cheeseman FD. Primary left atrial leiomyosarcoma simulating pulmonary thromboembolism. Can Assoc Radiol J 1994; 45: 48–51. Google Scholar ]. Leiomyosarcoma is a highly aggressive and local invasive tumor with mean survival of 6 months from the time of diagnosis, if the patient was not treated [ 3 Antunes MJ, Vanderdonck KM, Andrade CM, Rebelo LS. Primary cardiac leimyosarcoma. Ann Thorac Surg 1991; 51: 999–1001. Google Scholar ]. We present a case of pathologically proved left atrium leiomyosarcoma who received 2-dimensional (2-D) echocardiography, electron beam CT (EBCT) scan and cardiac MRI.

Ackerman's Surgical Pathology

Ackerman's Surgical Pathology

Ackerman's Surgical Pathology

'Monomania' from Karl Heinrich Baumgartner's Kranken-Physiognomik (Stuttgart: L. F. Rieger, 1842). From Seeing the Insane , by Sander L. Gilman, 252 pp, with illus, paper, $30, ISBN 0-8032-7064-X, Lincoln, Neb, University of Nebraska Press, 1982, 1996. The publication of the eighth edition of Ackerman's Surgical Pathology , the third under the aegis of Juan Rosai, is a welcome event for surgical pathologists. Since the last edition in 1989, the field of surgical pathology has continued to expand at an exponential rate. To reflect these advances, the new edition has been completely revised and updated. Dr Rosai again has succeeded in condensing the new information into a concise but comprehensive and readable text, maintaining the standard of excellence and uniformly high quality he achieved in the two prior editions. Six collaborators have written on the following subjects: Drs K. W. Barwick (liver—nonneoplastic diseases), N. G. Ordonez (kidney—nonneoplastic diseases), R. D. Brunning (bone marrow),

Ackerman's Surgical Pathology

Ackerman's Surgical Pathology

Ackerman's Surgical Pathology

Ackerman's Surgical Pathology