Humberto Trejo Bittar, MD, FCAP

@USFpathology Congratulations to all the future pathologists !

Congratulations to our incoming residents! We can’t wait to see you this July ☀️Happy Match Day everyone!!! #match2026 #pathmatch

Something to chew on 🦷 Out in the March issue of AJSP. Our study on super-peculiar tumors of tooth-forming tissues.. but arising in the lung. 🤔 x.com/natasharekhtma…

Case of the week, of course just before leaving for USCAP: Elderly male with a large right hilar mass and a separate spiculated smaller right lower lobe mass. Any suggestions based on the histologic sections (of the right lower lobe mass)? Clue: this is not a carcinoma, and the classic description of the neoplastic cells rhymes with “twister.” Final diagnosis will be shared after USCAP. #lung #pulmonary #pathology #lungpath #pulmpath #moffitt #meded #pathtwitter #raretumor @USFpathology @DrBuiPathology @rezaesh58

Being Chair of the @Pathologists Histotechnology Committee is a great honor and an opportunity to represent @MoffittNews within our national societies. Last weekend the Council of Scientific Affairs, of which I am a leadership member, met to discuss important practice issues affecting pathology. We had very important conversations on how to leverage AI and computational pathology for our PT and education programs, among many other topics. The future of pathology is here! #pathology #representation #advocacy

Interesting case of the day: Elderly male with a large right lower lobe/hilar mass, biopsied. I don’t often diagnose carcinosarcomas. This one is particularly interesting to examine. As a word of caution, I suggest correlation with a resection specimen to confirm the interpretation. Thanks @EHJPathDiva for your help on this case. Again, rare cases are not rare at @MoffittNews. Lung carcinosarcomas are rare and highly aggressive malignancies, accounting for less than 1% of all primary lung cancers. They occur most commonly in older adults, with a strong association with cigarette smoking, and typically present as large, centrally located masses discovered at an advanced stage. Epidemiologically, these tumors fall within the broader category of pulmonary sarcomatoid carcinomas, a group known for poor outcomes and limited therapeutic responsiveness. Diagnostically, lung carcinosarcomas pose significant challenges, particularly on small biopsies, because the sarcomatous component may overshadow or entirely obscure the epithelial element, leading to potential misclassification as a primary sarcoma or spindle cell neoplasm. Conversely, when only the carcinomatous portion is sampled, the biphasic nature may not be recognized, obscuring the correct diagnosis. Accurate identification requires careful morphologic assessment, broad immunohistochemical evaluation to highlight epithelial differentiation, and awareness of their clinicopathologic spectrum. Recognition is crucial, as these tumors behave aggressively, metastasize early, and demand appropriate oncologic management aligned with their high-grade biology. #lung #thoracic #pulmonary #pulmpath #thoracicpath #pathology #MedEd #PathTwitter @USFpathology

gofund.me/1c2f0da5e #GIPath #BSTPath #PulmPath #HemePath #BreastPath #GUPath Lets keep the fountain of knowledge flowing 🙂💫💫💫💫💫 Together we can keep this amazing project alive To recognize the value of sharing knowledge and sharing what we love most #PathTweetAward

Reminder: Not every rapidly growing spiculated lung nodule is malignant. Case: middle-aged man w/ prior thyroid Ca. Biopsy showed organizing granulomatous pneumonitis (mucicarmine neg). Thoughts? @smlungpathguy @USFpathology #lung #pulmpath #thoracicpath In cancer center path practice (@MoffittNews), pathologists must stay vigilant for unexpected Dx. While malignancy is focus, not every lesion is cancer—assuming so risks bias. Open, disciplined approach catches benign, inflammatory, infectious & non-neoplastic processes, prevents overdiagnosis & unnecessary Rx, and upholds path’s key role in patient care. Resisting anchoring & considering full differential is essential for accurate, thoughtful diagnoses.

Update: Not surprisingly, RNA fusion panel studies showed the characteristic FUS::DDIT3 fusion typical of myxoid liposarcomas.

I had a feeling today would bring an unexpected diagnostic twist. The patient presents with a solitary lung mass and a remote history of “thigh surgery,” though the nature of that prior procedure remains unclear. As I reviewed the morphology, a familiar pattern began to emerge—does this architecture remind anyone else of a particular entity? @USFpathology #Moffitt #lung #path #pulmpath #thoracic #thoracicpath #PathTwitter #MedEd One of the most rewarding aspects of thoracic pathology is the remarkable breadth of disease processes it encompasses. Each case offers a new opportunity to integrate knowledge across organ systems—whether encountering an unusual metastatic pattern, a previously unrecognized systemic manifestation, or a subtle variation in tumor biology. The constant interplay between pulmonary pathology and the wider landscape of human disease ensures that the field remains both intellectually stimulating and clinically impactful. Thoracic pathology truly exemplifies the excitement of diagnostic medicine: every slide is a new question, every pattern a clue, and every day a reminder of how dynamic and interdisciplinary our work can be.

The IHC is S100 by the way...

Case of the day update: For yesterday's case, whoever thought this was a granular cell tumor, you were right. The biopsies of this mass showed a proliferation of infiltrative round to oval to spindle-shaped neoplastic cells with hyperchromatic nuclei. There is moderate to marked nuclear pleomorphism but no significant increase in cellularity and no identifiable mitotic figures (and no elevated Ki-67 proliferation rate). The most striking microscopic finding was the presence of coarsely granular eosinophilic cytoplasm (PAS positive) with poorly delineated cell borders. Immunostains showed the neoplastic cells to be positive for S100 protein (mono- and polyclonal), CD56, and CD163, but negative for cytokeratins (CK7, AE1/AE3, and Cam5.2), synaptophysin, and chromogranin. The immunoprofile and morphologic features established the diagnosis of granular cell tumor. In addition to being a diagnostic challenge, as these tumors are an extremely rare entity (particularly in the mediastinum), I am having difficulty determining if this granular cell tumor is benign or malignant. A diagnosis of malignancy requires the presence of at least 3 of the following features: increased cellularity, tumor-type (geographic) necrosis, prominent spindle-shaped cells, increased nuclear-to-cytoplasmic ratio, vesicular nuclei with prominent nucleoli, marked pleomorphism, and increased mitotic activity (>2 mitoses per 2 mm²), as reported in Am J Surg Pathol. 1998 Jul;22(7):779-94. Any granular cell tumor with 1 or 2 of the above criteria can be referred to as atypical. #Moffitt #lung #pathology #path #thoracic #pulmpath #PathTwitter

@path_girl88 Please never feel like you will be judged or mocked for your opinions or thoughts on the cases I share. 😊

@drHTBlungpath Oh nice I thought it was a granular cell tumor but didn’t want to sound dumb 😅😅

Congrats to colleague Dr. Terry Boyle on receiving @MoffittNews 2026 Unsung Hero Award. This honors her yrs of exceptional dedication & behind-the-scenes leadership in translational research & clinical molecular diagnostics at Moffitt. Her work has been key to improving pt care & our mission. Key achievements: - Pioneered innovative clinical molecular diagnostic assays, expanding testing capabilities. - Instrumental in establishing & maintaining the Rapid Tissue Donation Program, a vital resource for pathology & translational research. - Provided consistent support for tumor boards w/ high-quality molecular interpretation. - Led research on RNA/protein expression in lung cancer & other tumors. - Always available (often on short notice) for complex mutation interp & lab questions. Dr. Boyle’s quiet dedication, scientific rigor, & support for colleagues truly define “unsung hero.” Well-deserved recognition for her impact on dept, institution, & pts. Congrats again! #Moffitt @rezaesh58 @DrBuiPathology @USFpathology #Congratulations

@padmapathology1 @KathiarRosado It is a mediastinal mass for sure :-)

@KathiarRosado @drHTBlungpath My first impression too. Without any more thoughts, i wondered if the site is possible 🙃

It is time for the case of the day: A middle-aged man presents with a large mediastinal mass in proximity to the pulmonary artery. During thoracotomy, a biopsy of the highly infiltrative and firm mass was performed. Here are representative images of the biopsy. Any thoughts about what this could be and the diagnostic work-up? #lung #thoracic #pulm #pathology #pulmpath #PathTwitter #thoracicpath @USFpathology #surprise #Moffitt

Happy fellows !

On National Thank a Resident and Fellow Day (February 27, 2026), we celebrate our residents and fellows whose commitment, curiosity, and compassion bring @MoffittNews’s purpose to life—to contribute to the prevention and cure of cancer—and accelerate ourvision to create revolutionary breakthroughs and innovations that rapidly impact and save more lives. Your efforts embody Moffitt values—excellence, ethical practice, collaboration, respect, and stewardship—in every case you work on, conference, frozen section, and consultations. Nowhere is this more evident than in pathology training, where your rigor and teamwork ensure the right diagnosis—the foundation on which effective cancer treatment begins—and advance the science that powers tomorrow’s care. Education and training are not just activities at Moffitt; they are a core part of our mission and a driver of our impact across our catchment area and beyond. Thank you for the excellence you deliver today and the discoveries you make possible tomorrow—we are proud to learn with you, practice with you, and grow with you. @USFpathology #pathology #residents #fellows @DrBuiPathology @EHJPathDiva @rezaesh58

It has been a busy couple of days. I'm not sure why I like this picture so much. This is something I still struggle with after almost 10 years as a thoracic pathologist. Is it adenocarcinoma or bronchiolar (metaplastic) epithelium? On top: adenocarcinoma cells with cancerization of this terminal bronchiole. The bronchiolar (ciliated but often barely ciliated as they become respiratory bronchioles, and p40 would help identifying basal cells) epithelium on the bottom. Cool, right? I love my job ! #lung #thoracic #path #pathology #moffitt #MedEd

We are so proud of our Residents and Medical Students for their excellent poster presentations this weekend! #FSP2026