Jamie Sington

@forthejon @et565 On morphology I would have gone for HG dysplastic naevus. PRAME and molecular seem to point in the same direction here and what you have said is v reasonable. Management is the same - wider excision.

@et565 shared a nice case - a borderline lesion in an elderly patient with IHC and molecular testing. I wrestle daily with these not-quite-frankly-malignant melanocytic neoplasms. kikoxp.com/posts/58349

@ChristineJKoMD @RACARR51 Agree - its a tremendous paper. Would recommend to anyone wanting an update in cutaneous SCC.

Such gorgeous figures, @RACARR51 ! a beautiful paper!! pubmed.ncbi.nlm.nih.gov/38648027/ #dermpath #pathology #Cancer

@STEVENKOLKERMD Just to play devils advocate Steven, why would you be uncomfortable or comfortable? If you have given the accurate measurement, this is as much as can be asked of you. Its up to the surgeon based on many factors to determine if it is adequate (unless you are the surgeon 😅).

That being said, it is concerning when the histologic clearance is 1 mm or less. I feel more comfortable when the histologic clearance is at least 2 mm.

Lentigo maligna (MIS) excised from cheek with histologic clearance of 2 mm is A) Adequate, good B) Adequate, concerning C) Inadequate, more surgery necessary IMO, 2 mm histologic clearance for MIS on the face, is good. Important not to confuse clinical & histologic margins

@DrMarkOng Gastric signet ring cell carcinoma?

Middle-aged female with pancytopaenia. What's the diagnosis? #pathology #pathX

@HENRYY_MD @RACARR51 @mccalmo @david_terrano @tonitatirado @MarcelaSaebL @et565 @DrGeeONE @kis_lorand @gonzadetoro @ChristineJKoMD @SGottesmanMD @VHNguyenMD @TristanRutland7 Follicular (infundibular) SCC

Verrucous squamous Lesion. 77 year old. hand. duration 10 years #dermapth Without @RACARR51 cocktail stains (P53, P16, Ki67), what would you call this lesion? I will not call it verrucous carcinoma for sure...@mccalmo @david_terrano @tonitatirado

@drtimbracey @RaulSGonzalezMD @Pathoutlines @diagnexia @DrCycloPath @Vik_deshpandeMD @drkeithsiau @LizMontgomeryMD @RhondaYantiss @TristanRutland7 @DrMarkOng Fabulous demo of the pathology Tim, thx.

Duodenal vasculitis with fibrinoid necrosis. The patient has systemic ANCA+ microscopic polyangiitis with mononeuritis multiplex. This can lead to GI bleeding so the vasculitis can show up in a D2 biopsy as long as the gastroenterologist gets a decent bite of submucosa #GIpath

@STEVENKOLKERMD I see this nearly every day!

Not many articles describing atypical squamous proliferations (well-differentiated SCC) within seborrheic and verrucous keratoses. It is actually not that rare. In those scenarios it is sometimes difficult to know whether they are truly SCC's or something less.

@david_terrano Thank you. Free to download too!

For all the non-believers in. Nested and DN-like melanomas, another data point to help you believe.

@DraEosina @drtimbracey @diagnexia @RaulSGonzalezMD @Pathoutlines @Pathmath1 @DrMarkOng @jansen_marnix @GIJamesMD @DrCycloPath @TristanRutland7 @Vik_deshpandeMD Do we know what the risk of malignancy is if we left these in situ after Bx?

@drtimbracey @diagnexia @RaulSGonzalezMD @Pathoutlines @Pathmath1 @DrMarkOng @jansen_marnix @GIJamesMD @DrCycloPath @TristanRutland7 @Vik_deshpandeMD I really wonder if these "dysplasias" are indeed neoplastic... Having no impact in outcome seem to argue against it, doesn't it?

Gastric fundic gland polyp excised after a prior biopsy diagnosis of low grade dysplasia. Foci of LGD marked, and arrows showing “apocrine-like” cytoplasmic snouts seen in patients on PPI medication #pathtwitter #GIPath #pathart @diagnexia

@mismatchdef A strong contender...

@drtimbracey @LumirKunovsky @UEGJournal @my_ueg @WileyHealth @Y_ECCO_IBD @imedverse @DCharabaty @JosephHabibi_MD @joostphdrenth @HaoYin20 @Bealoquebea @juliomayol @stevenbollipo @ibdseb @MariettaIacucci @DVinsard @RogerFeakins But they have to get to the epithelium somehow, presume transiting through the lamina propria - relevance depends on the context. If looks like UC / CD on scope, the findings of LP neutrs could be supportive of disease activity - might be bad luck you are missing cryptitis etc.

@LumirKunovsky @UEGJournal @my_ueg @WileyHealth @Y_ECCO_IBD @imedverse @DCharabaty @JosephHabibi_MD @joostphdrenth @HaoYin20 @Bealoquebea @juliomayol @stevenbollipo @ibdseb @MariettaIacucci @DVinsard Interesting work. We currently do not report neutrophils in lamina propria as evidence of colitis. To my knowledge they need to be intraepithelial. Can you comment on this @RogerFeakins ?

📢🔥 Epithelial neutrophil 🫐 localization & tight junction 🚧 Claudin-2️⃣ expression are innovative outcome #predictors in #inflammatory #bowel #disease 🔥 📕 only in @UEGJournal 🥰 👉tinyurl.com/2z48868w 🟢 @my_ueg 🟣 @WileyHealth 🔵 @Y_ECCO_IBD 🔴 #GITwitter @imedverse

@ArjunRamaiya1 Your image is beautiful; it is clearly sparing some suprabasal rete, and I wonder what you might call it if 'fully' confluent with similar atypia, no upward ascent or adnexal colonisation, but with PRAME positivity. Kossard believed lentig naevi of elderly = MIS if I'm correct?

@ArjunRamaiya1 I do hope they ask for further clarification 😆

@ArjunRamaiya1 @RishiAgraw21699 I think it can be quite difficult to know when budding + stromal reaction = (incipient) vs dermal invasion. Even more tricky when tumour has a pushing front in a superficial bx!

@drtimbracey @DrMarkOng @RunjanChetty @RahulADeb I recall TATs reducing in GI resections when we introduced them. Yes, great to look at but a really well described macro is fine for small blocks in complex cases. We seemed to manage before!!

@DrMarkOng @RunjanChetty @RahulADeb In our speciality we are very fortunate to be able to enjoy aesthetics on a daily basis even when it’s bad for the patient 😬 I do love a DOG1 on a normal salivary gland and a CD117 on a Giardia but have put a stop to those guilty pleasures like that while the lab are struggling.

We currently have a block cutting backlog in our lab and some of our staff use a lot of megablocks. In your lab are their guidelines for megablock use (eg. Certain specimen types) or can they be used for any type of specimen?

@DrMarkOng @drtimbracey @RunjanChetty @RahulADeb I think this means someone doesn't have enough work to do!

@drtimbracey @RunjanChetty @RahulADeb Sometimes an aesthetically pleasing megablock is the only guilty pleasure on a miserable day! In a previous job, a colleague managed to generate 80+ megablocks from a small number of mastectomies (don't ask!).

@RACARR51 Are they periungual?

2024 Wk31 RAC9148 F60s. 4 years h/o intermittent / transient subcutaneous small sometimes tender / firm nodules that can self resolve over days / weeks. No skin rash. Affects hands (dorsal & palmar areas). Help please #Dermpath A)Right thumb

@ArjunRamaiya1 Fantastic example Arjun. Totally agree - incisional and punch are nonsense here

@dgbrackett Seen a few times and not sure what to call, so usually go for post-inflammatory polyp or similar.

Gallbladder: At 1st glance, we thought this would be a cholesterol polyp, but on high power... no cholesterol! Come to find out, 15% of cases can be devoid of cholesterol-laden macrophages 🤯(Odze & Goldblum, 4th ed. p. 1226) Anyone have experience w/ this? Plz comment #GIpath

@ArjunRamaiya1 Panfolliculoma.