Usual Interstitial Pneumonia in Contemporary Surgical Pathology Practice: Impact of International Consensus Guidelines for Idiopathic Pulmonary Fibrosis on Pathologists.

CONTEXT.­: Idiopathic pulmonary fibrosis is a clinical syndrome characterized by the presence of usual interstitial pneumonia (UIP) radiologically and pathologically. Per consensus criteria adopted in 2011, diagnosis of idiopathic pulmonary fibrosis no longer requires a biopsy in an appropriate context if UIP is seen on imaging. As a result, lung biopsies are now typically reserved for patients having indeterminate clinical or imaging findings or suspicion for alternative diagnoses, but the impact of updated guidelines on pathology practice remains unclear. OBJECTIVE.­: To determine the frequency of histologic UIP before and after 2011. DESIGN.­: Surgical lung biopsies from adults were studied within two 4-year periods: July 1, 2006 through June 30, 2010 and January 1, 2012 through December 31, 2015. Pathology slides were reviewed in a fashion blinded to clinical information and were classified using current guidelines. RESULTS.­: Biopsies from 177 and 86 patients (mean [SD] age, 62 [12] and 59 [14] years; 50.3% [89 of 177] and 48.8% [42 of 86] men) before and after 2011, respectively, were reviewed. Probable UIP or UIP was less-frequently encountered after 2011 in all patients with fibrosis (9 of 54 [16.7%] versus 41 of 119 [34.5%] before 2011, P = .02) and also in patients 50 years old and older (8 of 46 [17.4%] versus 39 of 109 [35.8%] before 2011, P = .02), with a concomitant rise in cases indeterminate for UIP or showing alternative diagnoses. CONCLUSIONS.­: Histology for UIP is less frequently encountered in our contemporary practice compared with the historic era. The pretest probability of a non-UIP diagnosis is now high, even in elderly patients, underscoring the need for pathologists to be familiar with the histologic features of alternative diagnoses.

A rare case of pancreatic adenocarcinoma metastasized to the bladder.

Pancreatic cancer is usually detected in late stages due to lack of identifiable symptoms and rapid progression. It commonly metastasizes to the liver, lung, and peritoneum, but only rarely to the bladder. We present a 41-year-old female with a history of pancreatic adenocarcinoma, asthma, gastroesophageal reflux disease, uterine fibroids, and tobacco use who presented with hematuria, polyuria, and abdominal pain. The CT showed bilateral hydroureteronephrosis with a hyperdense region in the posterior wall of the bladder. Pathology revealed metastatic pancreatic adenocarcinoma to the bladder. This is the fourth reported case of pancreatic adenocarcinoma metastasizing to the bladder since 1953.

Seminal Vesicle Leiomyoma Mimicking Extra-prostatic Extension of Prostatic Adenocarcinoma.

Leiomyomas are common smooth muscle neoplasms; however, leiomyomas of the seminal vesicles are extremely rare. We report a case of seminal vesicle leiomyoma in a 55-year-old African American male who underwent robot assisted laparoscopic prostatectomy (RALP) for Gleason 8 (4 + 4) adenocarcinoma. An incidental nodule arising from the left seminal vesicle was discovered during surgery, complicating the surgical dissection and suggesting extra-prostatic extension. The histologic findings in this case raised the possibility that this seminal vesicle leiomyoma may have arisen from a remnant of the mid-portion of the Müllerian duct; however, a thorough immunohistochemical (IHC) workup disproved this theory.