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Mesenchymal tumours of the gut
Pathology (2015) 47(S1), pp. S7–S9
Anatomical Pathology, Oral and Maxillofacial Pathology
MESENCHYMAL LESIONS (AND MIMICS) IN THE BREAST Christopher D. M. Fletcher Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA This lecture will provide a brief overview of benign and malignant spindle cell neoplasms, as well as vascular lesions, of the breast. Key take home points are that primary spindle cell sarcomas arising in the breast are very rare and that metaplastic (sarcomatoid) carcinoma is always a more likely consideration. Multiple keratin stains may be necessary to exclude the latter. Among truly intraparenchymal vascular lesions, angiosarcoma is always a serious possibility and it is nowadays appreciated that all mammary angiosarcomas have a significant risk of distant metastasis, irrespective of histological grade. Among benign lesions, needle biopsies from angiolipoma in the breast (usually subcutis) often cause diagnostic difficulty. Increasingly more common post-radiation vascular lesions of breast skin will also be reviewed.
MESENCHYMAL TUMOURS OF THE GUT Chris Hemmings St John of God Pathology WA; School of Surgery, University of Western Australia, Perth, WA, Australia Gastrointestinal stromal tumour (GiST) is now recognised as the most common mesenchymal malignancy of the gut. With a little experience most cases are fairly easy to diagnose, although some unusual morphological variants exist. But whereas diagnosis is generally quite straightforward, prognostication is more difficult. A variety of risk stratification schemata have been developed, but none is infallible and the pathologist is left with a number of imperfect options for predicting how a particular tumour will behave. The better known of these will be canvassed and some guidance offered as to what information should be included in a comprehensive pathology report. Some other, less common mesenchymal tumours which may at times enter the differential diagnosis of GiST will also be considered.
and Crohn’s disease predominantly comprising the chronic category. However, pathobiology rarely conforms to our attempts at neat categorisation. Numerous other forms of chronic colitis have been described in addition to Crohn’s disease and ulcerative colitis; furthermore, we now recognise an increasing number of variations of ischaemic colitis and drug or chemicalrelated colitis. This lecture will address the diagnostic criteria for separating chronic inflammatory bowel disease from selflimited processes, and will also address the biopsy diagnosis of chronic idiopathic inflammatory bowel disease and the so-called atypical colitides. Examples of infectious colitis, drug/chemicalrelated colitis, and variants of ischaemic colitis will also be discussed.
DIAGNOSTIC PITFALLS IN GASTROINTESTINAL AND HEPATIC PATHOLOGY Laura W. Lamps Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA Many of us learn very effectively from mistakes that we have made, and from trying to avoid repeating our errors. Although many textbooks, scientific articles, and courses are available that address the differential diagnoses of pathological entities encountered in the practice of GI and hepatic pathology, there are very few resources that address specific errors encountered during daily, ‘real-life’ practice (both in the evaluation of biopsies and surgical specimens). Furthermore, the increased use of endoscopy in the evaluation of patients with gastrointestinal complaints has resulted in a tremendous increase in the variety and complexity of diseases encountered by surgical pathologists. In addition, if the endoscopy is performed at a location remote from the pathologist, obtaining essential clinical and endoscopic information can be very difficult (which may in turn contribute to the likelihood of making an error). This lecture will address some common mistakes and pitfalls in the diagnosis of GI and hepatic pathology, using specific problematic cases that illustrate errors and pitfalls.
THE EVOLVING CLASSIFICATION OF SOFT TISSUE TUMOURS – WHAT’S NEXT? BIOPSY EVALUATION OF NON-NEOPLASTIC DISEASES OF THE LARGE BOWEL: AN ALGORITHMIC APPROACH
Christopher D. M. Fletcher Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
Laura W. Lamps Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
With the advent of the new format for WHO tumor classifications, there have been major changes in each of the most recent volumes (2002 and 2013) concerning soft tissue neoplasms. Perhaps foremost has been the disappearance of ‘malignant fibrous histiocytoma’ and ‘hemangiopericytoma’. In 2013 the category of undifferentiated sarcomas was introduced and a very large amount
Classically, pathologists often divide inflammatory diseases of the large bowel into acute and chronic forms, with ulcerative colitis Print ISSN 0031-3025/Online ISSN 1465-3931
#
2015 Royal College of Pathologists of Australasia
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.
Anatomical Pathology, Oral and Maxillofacial Pathology
MESENCHYMAL LESIONS (AND MIMICS) IN THE BREAST Christopher D. M. Fletcher Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA This lecture will provide a brief overview of benign and malignant spindle cell neoplasms, as well as vascular lesions, of the breast. Key take home points are that primary spindle cell sarcomas arising in the breast are very rare and that metaplastic (sarcomatoid) carcinoma is always a more likely consideration. Multiple keratin stains may be necessary to exclude the latter. Among truly intraparenchymal vascular lesions, angiosarcoma is always a serious possibility and it is nowadays appreciated that all mammary angiosarcomas have a significant risk of distant metastasis, irrespective of histological grade. Among benign lesions, needle biopsies from angiolipoma in the breast (usually subcutis) often cause diagnostic difficulty. Increasingly more common post-radiation vascular lesions of breast skin will also be reviewed.
MESENCHYMAL TUMOURS OF THE GUT Chris Hemmings St John of God Pathology WA; School of Surgery, University of Western Australia, Perth, WA, Australia Gastrointestinal stromal tumour (GiST) is now recognised as the most common mesenchymal malignancy of the gut. With a little experience most cases are fairly easy to diagnose, although some unusual morphological variants exist. But whereas diagnosis is generally quite straightforward, prognostication is more difficult. A variety of risk stratification schemata have been developed, but none is infallible and the pathologist is left with a number of imperfect options for predicting how a particular tumour will behave. The better known of these will be canvassed and some guidance offered as to what information should be included in a comprehensive pathology report. Some other, less common mesenchymal tumours which may at times enter the differential diagnosis of GiST will also be considered.
and Crohn’s disease predominantly comprising the chronic category. However, pathobiology rarely conforms to our attempts at neat categorisation. Numerous other forms of chronic colitis have been described in addition to Crohn’s disease and ulcerative colitis; furthermore, we now recognise an increasing number of variations of ischaemic colitis and drug or chemicalrelated colitis. This lecture will address the diagnostic criteria for separating chronic inflammatory bowel disease from selflimited processes, and will also address the biopsy diagnosis of chronic idiopathic inflammatory bowel disease and the so-called atypical colitides. Examples of infectious colitis, drug/chemicalrelated colitis, and variants of ischaemic colitis will also be discussed.
DIAGNOSTIC PITFALLS IN GASTROINTESTINAL AND HEPATIC PATHOLOGY Laura W. Lamps Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA Many of us learn very effectively from mistakes that we have made, and from trying to avoid repeating our errors. Although many textbooks, scientific articles, and courses are available that address the differential diagnoses of pathological entities encountered in the practice of GI and hepatic pathology, there are very few resources that address specific errors encountered during daily, ‘real-life’ practice (both in the evaluation of biopsies and surgical specimens). Furthermore, the increased use of endoscopy in the evaluation of patients with gastrointestinal complaints has resulted in a tremendous increase in the variety and complexity of diseases encountered by surgical pathologists. In addition, if the endoscopy is performed at a location remote from the pathologist, obtaining essential clinical and endoscopic information can be very difficult (which may in turn contribute to the likelihood of making an error). This lecture will address some common mistakes and pitfalls in the diagnosis of GI and hepatic pathology, using specific problematic cases that illustrate errors and pitfalls.
THE EVOLVING CLASSIFICATION OF SOFT TISSUE TUMOURS – WHAT’S NEXT? BIOPSY EVALUATION OF NON-NEOPLASTIC DISEASES OF THE LARGE BOWEL: AN ALGORITHMIC APPROACH
Christopher D. M. Fletcher Department of Pathology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
Laura W. Lamps Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
With the advent of the new format for WHO tumor classifications, there have been major changes in each of the most recent volumes (2002 and 2013) concerning soft tissue neoplasms. Perhaps foremost has been the disappearance of ‘malignant fibrous histiocytoma’ and ‘hemangiopericytoma’. In 2013 the category of undifferentiated sarcomas was introduced and a very large amount
Classically, pathologists often divide inflammatory diseases of the large bowel into acute and chronic forms, with ulcerative colitis Print ISSN 0031-3025/Online ISSN 1465-3931
#
2015 Royal College of Pathologists of Australasia
Copyright © Royal College of pathologists of Australasia. Unauthorized reproduction of this article is prohibited.