@pathoblog

Pathologist who loves a good diagnostic puzzle 🔬 | Educator at heart | Here to share cases, tips & the occasional plot twist under the microscope

instagram.com/pathoblog
Joined March 2020
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🧵 1/9 Elderly male. Metastatic colorectal cancer with liver mets. RAS wild-type — looks straightforward. Then the molecular profile comes back: HER2 IHC 3+. This changes the entire treatment plan. Here's why 👇
colorectal adenocarcinoma with HER2 expression

ALT colorectal adenocarcinoma with HER2 expression

colorectal adenocarcinoma with HER2 expression

ALT colorectal adenocarcinoma with HER2 expression

colorectal adenocarcinoma with HER2 expression

ALT colorectal adenocarcinoma with HER2 expression

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8/9 Key detail on testing 🔬 IHC 3+ responds well. IHC 2+ without amplification — almost no benefit. Use HERACLES criteria, not breast cancer scoring. And when possible, test the metastatic tissue — not just the primary.
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9/9 The takeaway: 🔵 HER2 3+ rules out anti-EGFR therapy 🔵 Opens access to two approved targeted regimens 🔵 Age is not a reason to treat blind Test it, it really matters. #gipath #pathtwitter #pathology
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Anna Vasileva retweeted
Jerad Gardner, MD
@JMGardnerMDApr 30
Hard time remembering all those #hemepath immunostains/markers? This chart by Dr. Jeanette Ramos will help! Full chart free here: kikoxp.com/posts/20554. #medstudents #pathTwitter #path2path #usmle #MedStudentTwitter #MedED #medtwitter #hematology #hemeonc #lymphoma #leukemia
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🧵 1/6 A nodule on the face. Sent as a skin biopsy. No clinical history provided. Spoiler: this is NOT a primary skin tumor. 👇 #pathtwitter #dermpath #uropath #pathology
H&E staining. Skin biopsy: intact epidermis and a dermal tumor composed of clear cells, separated by a prominent network of thin-walled vessels.

ALT H&E staining. Skin biopsy: intact epidermis and a dermal tumor composed of clear cells, separated by a prominent network of thin-walled vessels.

H&E staining. Skin biopsy: intact epidermis and a dermal tumor composed of clear cells, separated by a prominent network of thin-walled vessels.

ALT H&E staining. Skin biopsy: intact epidermis and a dermal tumor composed of clear cells, separated by a prominent network of thin-walled vessels.

H&E stain. High-power view showing tumor cells with abundant clear cytoplasm and small, round, uniform nuclei. Thin-walled vessels are visible between tumor cell nests.

ALT H&E stain. High-power view showing tumor cells with abundant clear cytoplasm and small, round, uniform nuclei. Thin-walled vessels are visible between tumor cell nests.

H&E stain. High-power view showing tumor cells with abundant clear cytoplasm and small, round, uniform nuclei. Thin-walled vessels are visible between tumor cell nests.

ALT H&E stain. High-power view showing tumor cells with abundant clear cytoplasm and small, round, uniform nuclei. Thin-walled vessels are visible between tumor cell nests.

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5/6 📌 Take-home points: — Clear cells in skin = always rule out metastasis — RCC loves to metastasize late and to unusual sites — PAX8 + CD10 + CAIX = your best IHC friends here
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6/6 Bottom line: clinical history is not just background noise — it is part of the diagnosis. Never forget that 🔑 Have you ever seen a case like this? 👇
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1/3 #GIpath #CritterOnTwitter Look what I found in this inflamed antral hyperplastic gastric polyp 🤓. At first glance, I thought that it is hallucinations or illusions due to end of the week fatigue 😂 then I started to take images of every single one. So all are represented 😅
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Charlie Herndon@DrCycloPathApr 30
#PathQuiz 🔬🦋 #ThyroidPath A) NIFTP B) High-grade follicular cell-derived thyroid carcinoma C) Oncocytic Carcinoma D) Invasive Encapsulated Follicular Variant of Papillary Thyroid Carcinoma #Pathology #ThyroidPath
A 48-year-old woman presents with a solitary, well-demarcated thyroid mass. Capsular invasion. @IARCWHO

ALT A 48-year-old woman presents with a solitary, well-demarcated thyroid mass. Capsular invasion. @IARCWHO

Note the unequivocal penetration through the thick fibrous capsule and into adjacent vascular spaces.

ALT Note the unequivocal penetration through the thick fibrous capsule and into adjacent vascular spaces.

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Raza Hoda, MD
@RazaHodaApr 30
ADH in Radial Scar 🫚🔬 Occasionally, atypia can be spotted within sclerosing lesions—here, a monotonous epithelial proliferation partially filling ducts within a fibroelastotic, architecturally distorted background. #PathX #PathTwitter #breastpath
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🧵 Not all breast carcinomas are created equal 🧬 Here's how p63 expression shifts as tumors progress toward a basal/stem-cell phenotype👇 #pathtwitter #breastpath #pathology
Illustrated diagram showing p63 expression across three breast tumor types. Tumor 1 (G1/G2 NST): uniformly blue cells, p63-negative. Tumor 2 (G3 NST): predominantly blue cells with scattered brown cells, p63-positive, triggered by TP53 mutation. Tumor 3 (Metaplastic carcinoma): predominantly brown cells, p63-strongly positive. An arrow along the bottom indicates increasing basal program activation, aggressiveness, and stem-cell phenotype from left to right.

ALT Illustrated diagram showing p63 expression across three breast tumor types. Tumor 1 (G1/G2 NST): uniformly blue cells, p63-negative. Tumor 2 (G3 NST): predominantly blue cells with scattered brown cells, p63-positive, triggered by TP53 mutation. Tumor 3 (Metaplastic carcinoma): predominantly brown cells, p63-strongly positive. An arrow along the bottom indicates increasing basal program activation, aggressiveness, and stem-cell phenotype from left to right.

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🔵 G1/G2 NST → p63− 🟤 G3 NST → p63+ (e.g. TP53 mutation as a trigger) 🟤🟤 🟤 Metaplastic carcinoma → p63+++ The more basal the program — the more aggressive the tumor. Metaplastic carcinoma is the extreme end of this spectrum.
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