International Society of Urological Pathology Consensus Conference on Renal Neoplasia

The International Society of Urological Pathology (ISUP) is the international professional organization dedicated to the subspecialty of urological pathology. [...] In 2011 the Society undertook to review all aspects of the pathology of adult renal malignancy through an international consensus conference [...]. The detailed decisions relating to the consensus conference are presented in 4 reports, included this issue of the journal.

Delahunt B, Egevad L, Montironi R, Srigley JR. International Society of Urological Pathology (ISUP) Consensus Conference on Renal Neoplasia: Rationale and Organization. Am J Surg Pathol. 2013 Oct;37(10):1463-8.

American Journal of Surgical Pathology

Volume 37(10) pgs. 1463-1633 October 2013

Srigley JR, et al The ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Vancouver Classification of Renal Neoplasia. Am J Surg Pathol. 2013 Oct;37(10):1469-1489.

Delahunt B,et al, The Members of the ISUP Renal Tumor Panel. The International Society of Urological Pathology (ISUP) Grading System for Renal Cell Carcinoma and Other Prognostic Parameters. Am J Surg Pathol. 2013 Oct;37(10):1490-1504.

Trpkov K, et al; the members of the ISUP Renal Tumor Panel. Handling and Staging of Renal Cell Carcinoma: The International Society of Urological Pathology Consensus (ISUP) Conference Recommendations. Am J Surg Pathol. 2013 Oct;37(10):1505-1517.

Tan PH, et al, The ISUP Renal Tumor Panel. Renal Tumors: Diagnostic and Prognostic Biomarkers. Am J Surg Pathol. 2013 Oct;37(10):1518-1531.

A 69-year-old man, with a history of renal cancer 11 years ago, presented with a 1 cm right lung nodule, which was investigated with fine-needle aspiration under computed tomography guidance. A, Cell block preparation shows tumor cells with pink cytoplasm. B, Higher magnification of tumor cells with pink cytoplasm and nuclei that are vesicular and hyperchromatic. C, Immunohistochemical analysis with RCC marker shows strong cytoplasmic reactivity. D, Pax 2 immunohistochemistry reveals strong nuclear staining, confirming a metastasis to the lung from a primary renal tumor.

Pax 2 and/or Pax 8 were considered to be the most useful markers in the diagnosis of a renal primary.

(from Tan PH, et al, Diagnostic and Prognostic Biomarkers)

P.S. Post n. 100! 

Vessels of Stone: Lenin's "Circulatory Disturbance of the Brain"

Many have wondered what might have become of the totalitarian state Lenin founded on merciless terror, had he not died so young. He was 52 and at the height of his power when he had his first stroke. Six months later he had another and then a third stroke three months after that. He died 3 months shy of his 54th birthday with cerebral arteries so calcified that when tapped with tweezers at the time of his autopsy, they sounded like stone. The reason for his premature atherosclerosis has yet to be explained. He had a family history of cardiovascular disease and, therefore, is suspected of having had an inherited lipid disorder. Stress too might have had a role in the progression of his atherosclerosis. However, neither would explain the extent of the calcification of his cerebral arteries identified at post mortem examination. A recently described variant of the NT5E mutation might explain such calcification, as well as Lenin's family history of cardiovascular disease, and his premature cerebrovascular attacks.

Vinters H, Lurie L, Mackowiak PA. Vessels of Stone: Lenin's "Circulatory Disturbance of the Brain". Hum Pathol. 2013 Feb 18.

On the morning of January 23, 1924, the pathologist Alexei Ivanovich Abrikosov was given a task to embalm Lenin's body to keep it intact until the burial. The body is still on permanent display in the Lenin Mausoleum in Moscow. (source Wikipedia)

(to note, Abrikosov has also described the so-called Abrikosov's tumor aka Granular cell tumor)

Looking too closely at thyroid nodules

Endocrinologi e patologi sono certamente co-responsabili dell' incrementata incidenza dei tumori della tiroide. Troppi noduli vengono inviati all' agoaspirato, troppi pazienti subiscono un intervento chirugico e troppe neoplasie a differente comportamento biologico e clinico vengono riunite sotto la stessa terminologia. Un corretto studio clinico può certamente evitare inutili FNA che, talora, vengono utilizzati dai clinici anche in funzione "difensiva". Così come può essere limitata l' indicazione all' intervento chirurgico, applicando agli aspirati i criteri classificativi correnti. Ad esempio, la maggior parte delle citologie "atipiche" (AUS/FLUS) può essere risolta con la semplice ripetizione dell' aspirato (con un risultato il più delle volte di benignità). Diverso il discorso per le lesioni follicolari. Considerata l' incidenza piuttosto bassa del carcinoma follicolare siamo costretti, a causa dei limiti dell' FNA, a mandare consapevolmente molti adenomi follicolari all' intervento chirurgico. Le tecniche di biologia molecolare basate sui profili di espressione genica, aumentano il valore predittivo negativo dell' aspirato "indeterminato", ma non riescono a discriminare (ancora) meglio della morfologia le lesioni effettivamente maligne. Inoltre, sono costose e attualmente non applicabili alla routine clinica. Infine, carcinomi indolenti vengono ancora classificati insieme a quelli a comportamento aggressivo, i cosiddetti "real thyroid carcinomas". Molti carcinomi papillari, come è noto, hanno un comportamento "benigno", come testimoniano i numerosi incidentalomi scoperti nelle sezioni seriate di gozzi nodulari o nelle autopsie di pazienti deceduti per altre cause. Sforzi di correlazione clinica, morfologica e molecolare devono essere fatti per separare i tumori a basso potenziale dai veri carcinomi tiroidei, in modo da ottimizzare efficacemente il managment dei pazienti con patologia nodulare tiroidea.

Bibliografia.

Brito JP, Morris JC, Montori VM. Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ. 2013 Aug 27;347:f4706.

Renshaw AA. How closely do thyroid fine-needle aspirates need to be screened? Diagn Cytopathol. 2002 Nov;27(5):259-60

Alexander EK. et al, Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N Engl J Med. 2012 Aug 23;367(8):705-15. Epub 2012 Jun 25.

Faquin WC. Can a gene-expression classifier with high negative predictive value solve the indeterminate thyroid fine-needle aspiration dilemma? Cancer Cytopathol. 2013 Mar;121(3):116-9.

Baloch Z, Livolsi VA, Tondon R. Aggressive variants of follicular cell derived thyroid carcinoma; the so called 'Real Thyroid Carcinomas'. J Clin Pathol. 2013 Sep;66(9):733-43.