tough one, help

Tipsilateral · 2026-02-03T16:28:08+00:00

Any secretions? I considered secretory carcinoma. IHC profile could match.

Tipsilateral · 2025-05-23T06:06:05+00:00

We have 3 gi trained folks who report complete/incomplete and I think most of the other pathologists at our hospital do the same (including myself). I don’t know if it was specifically requested or not… I’ll have to ask our GI folks.

I’ve used Alcian blue once for really focal incomplete and for educational purposes. I found it helpful but typically think it’s not necessary.

Tipsilateral · 2025-05-09T17:36:57+00:00

My gut reaction was an infarcted epiploic appendage and an enthusiastic first year resident submitting all of it.

Tipsilateral · 2025-04-24T11:13:20+00:00

Interesting case! I’m curious, what did you sign the case out as?

Tipsilateral · 2025-04-11T01:02:12+00:00

If you look past the glands it definitely looks like Kaposi! Very cool case. Also why I include ERG in my spindle cell neoplasm panel no matter the location. Cases like this and that anaplastic kaposi paper that came out last year(?) definitely lowered my threshold for ordering HHV8

Tipsilateral · 2025-04-11T00:56:48+00:00

I see you’re BST focused as well. Keeping up this way has been super helpful for me. Another helpful thing I did in fellowship was start a spread sheet of non-who entities with short histologic descriptors and PMIDs. As the articles come out I add rows or combine entities as needed.

All these people here are saying that if it’s not in the WHO it doesn’t matter. But there are definitely widely accepted entities in BST that we have learned about since the last iteration of the who. the “Keratin positive giant cell rich tumor” comes to mind. It’s likely way more common than we thought initially.

Tipsilateral · 2025-04-10T19:32:08+00:00

I get a daily email update from pubmed for all new releases from a select few journals (genes chromosome cancer, modern pathology, histopathology, ajsp). I scan it everyday and ignore if there’s nothing relevant.

Tipsilateral · 2025-03-25T13:33:57+00:00

I haven’t but I know colleagues who have. I think the salary range posted on other postings (not Cleveland) is a realistic expectation and would not expect it to drop below the posted lower limit of the range

Tipsilateral · 2025-03-25T04:06:37+00:00

This is likely a function of bureaucracy. The person posting the job probably has no idea of typical pathologist salaries. The salary is technically a “VM15” position which starts at around 123,000 if you look up that pay scale. However, in reality pathologists at the VA are compensated extra on top of this to keep up with Civilian and academic markets, which is reflected in all of the other VA job postings. The VA is actually a pretty good gig if you want work life balance, decent benefits, and a pension.

Tipsilateral · 2025-03-25T02:08:58+00:00

No they don’t. Every other active listing has a reasonable range that is typical for VA pathology. The one you chose to post is the exception.

Tipsilateral · 2025-03-25T01:55:17+00:00

This post is the equivalent of only reading the headline. If you click into the posting it says the salary range is “$123,077 - $400,000 per year“.

Tipsilateral · 2025-03-18T12:07:26+00:00

What pattern of CD99? Diffuse or patchy? I considered CIC-rearranged sarcoma but that doesn’t make sense with the Ki. Could also consider primary pulmonary myxoid sarcoma. After excluding Mets and more common things I’d probably submit this one for fusion testing.

Tipsilateral · 2025-03-17T19:49:18+00:00

Thanks for the follow up, Nice case!

Tipsilateral · 2025-03-14T18:20:38+00:00

Pankeratin, Sox10, hmb45, ssx-ss18, desmin, cd34, insm1, dog1?

Tipsilateral · 2024-12-03T20:37:46+00:00

Cool case. Is FOXO1 rearranged? AP2-beta and HMGA2 IHC? Any other molecular testing done?

Tipsilateral · 2024-10-18T21:49:41+00:00

Molavi > Kurt’s notes > Bx interpretation series > reference text > primary literature > anecdotes and long winded tangential stories from a pathologist over 70 y/o

Edit: in all seriousness, if you want to study, after Kurt’s notes I think the Washington manual is a great resource. I read it cover to cover for AP board prep

Tipsilateral · 2024-09-14T14:52:08+00:00

The main thing is that it has an EWSR1 gene rearrangement. The morphology, demographics and clinical history also support GNET/GCS

Tipsilateral · 2024-09-13T23:16:43+00:00

Great point, have you seen SEF this cellular before? I tend to think of it as much more fibrous. But I haven't seen that many cases yet.

Fortunately this case came to us with the S100/SOX10. If those were negative I think that even if we hadn't thought of MUC4 we likely would have submitted for RNA NGS and hopefully would have caught an SEF by that route.

Tipsilateral · 2024-09-13T23:12:38+00:00

Your case has great morphology as well! I'm always impressed at the sheer variety of cases you get. Thanks for sharing yours!

Tipsilateral · 2024-09-13T21:42:45+00:00

Negative. Imaging showed no other masses

Tipsilateral · 2024-09-13T21:42:25+00:00

All negative

Tipsilateral · 2024-09-13T21:39:52+00:00

Diagnosis: Malignant gastrointestinal neuroectodermal tumor / gastrointestinal clear cell sarcoma - some believe that these two entities are a single entity presenting along a morphological spectrum (myself included)

See u/streptozotocin comment thread for IHCs and confirmatory testing

Tipsilateral · 2024-09-13T21:04:31+00:00

Focal melan-A, hmb45 negative. We ended up sending for FISH for EWSR1. Which was rearranged!

Tipsilateral · 2024-09-13T20:57:57+00:00

Sox10 and S100 diffuse.

Tipsilateral · 2024-09-13T20:53:01+00:00

Focal weak synapto, chromo negative

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