Xpert Bladder Cancer Monitor for the Early Detection of Non-Muscle Invasive Bladder Cancer Recurrences: Could Cystoscopy Be Substituted?

XBM was prospectively assessed in spontaneous urine collected just before flexible cystoscopy and washing cytology carried out within the first 2 years follow-up of 337 patients with NMIBC. Recurrences were pathologically confirmed in 49 patients (14.5%), 22 of them being high-risk (6.5%). The XBM sensitivity for detecting any type of recurrence was 69.4% and 63.6% in the cases of high-risk NMIBC. Negative predictive value (NPV) for XBM was 93% for all recurrences and 96.2% for high-risk recurrences. XBM could have avoided 213 invasive controls but missed the detection of 15 recurrences (30.6%)-8 of them of high-risk (36.4%). XBM false positive elevations were detected in 90 patients (26.7%), whereas 10 patients with the invasive method had a false positive result (3%), p <0.001. However, early detection of recurrences during the first year's follow-up after an XBM false positive result was observed in 18 patients (20%). On the other hand, 19 recurrences were detected during this period among the rest of the patients (7.7%)-p = 0.003, and odds ratio (OR) 3.0 (95% CI 1.5-6.0). Regarding one-year follow-up recurrences, 10% were high-risk recurrences in the XBM false positive group and 3.2% in the rest of the patients-p = 0.021, and OR 3.3 (95% CI 1.2-8.9). Additionally, 11.3% of the patients without false positive results developed a recurrence, p = 0.897, for any recurrence, being 10% and 5.2%, respectively, and high-risk and low-risk recurrences, p = 0.506. After searching for the best XBM cutoff for detecting the 38 high-risk initial recurrences and the early high-risk recurrences after a one-year follow-up, a linear discriminant analysis (LDA) of 0.13 could have avoided 11.3% of cystoscopies and bladder wash cytologies, as this cutoff missed only 1 high-risk recurrence (2.6%). More extensive and well-designed studies will confirm if XBM can improve the surveillance of NMIBC.

Hybrid neurofibroma/schwannoma of the orbit / Tumor híbrido neurofibroma/schwannoma de la órbita

Hybrid neurofibroma/schwannoma is a rare variant of hybrid peripheral nerve sheath tumours (HPNST). A Medline search up to December 2021 identified only six cases of this tumour in the orbit. We report the case of a 78-year-old man who presented with left exophthalmos. Computed tomography showed a left intraconal orbital mass. The clinico-radiological diagnosis was consistent with an intraconal cavernous angioma. Orbitotomy was performed, obtaining an 18×16×11mm mass. Two different morphologies were seen microscopically, diagnostic of hybrid neurofibroma/schwannoma. HPNSTs of the orbit are uncommon and most reported cases showed a hybrid neurofibroma/schwannoma morphology. Hybrid neurofibroma/schwannomas have been associated with neurofibromatosis and schwannomatosis. Local recurrences have been reported. The correct identification of these tumours is important due to their potential use as a syndromic marker.(AU)

El tumor híbrido neurofibroma/schwannoma es una lesión rara incluida dentro de tumores híbridos de la vaina del nervio periférico. Mediante revisión bibliográfica en Medline hasta diciembre de 2021 se identificó solo seis casos de este tumor en la órbita. Presentamos el caso de un varón de 78 años que consultó por exoftalmos izquierdo. La tomografía computarizada mostró una masa orbitaria intraconal izquierda. El diagnóstico clínico-radiológico fue compatible con angioma cavernoso intraconal. Se realizó una orbitotomía, obteniendo una masa de 18×16×11mm. Microscópicamente, el tumor mostró dos morfologías diferentes compatibles con tumor híbrido neurofibroma/schwannoma. Los tumores híbridos de la vaina del nervio periférico de la órbita son poco comunes. La mayoría de los casos informados muestran una morfología híbrida de neurofibroma/schwannoma. El tumor híbrido neurofibroma/schwannoma se ha asociado con neurofibromatosis y schwannomatosis. Se han reportado recurrencias locales. La correcta identificación de estos tumores es relevante debido a su potencial uso como marcador sindrómico.(AU)

Hybrid neurofibroma/schwannoma of the orbit.

Hybrid neurofibroma/schwannoma is a rare variant of hybrid peripheral nerve sheath tumours (HPNST). A Medline search up to December 2021 identified only six cases of this tumour in the orbit. We report the case of a 78-year-old man who presented with left exophthalmos. Computed tomography showed a left intraconal orbital mass. The clinico-radiological diagnosis was consistent with an intraconal cavernous angioma. Orbitotomy was performed, obtaining an 18×16×11mm mass. Two different morphologies were seen microscopically, diagnostic of hybrid neurofibroma/schwannoma. HPNSTs of the orbit are uncommon and most reported cases showed a hybrid neurofibroma/schwannoma morphology. Hybrid neurofibroma/schwannomas have been associated with neurofibromatosis and schwannomatosis. Local recurrences have been reported. The correct identification of these tumours is important due to their potential use as a syndromic marker.

Overview and update on molecular testing in non-small cell lung carcinoma utilizing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples.

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non-small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.

#EBUSTwitter: Novel Use of Social Media for Conception, Coordination, and Completion of an International, Multicenter Pathology Study.

CONTEXT.­: Social media sites are increasingly used for education, networking, and rapid dissemination of medical information, but their utility for facilitating research has remained largely untapped. OBJECTIVE.­: To describe in detail our experience using a social media platform (Twitter) for the successful initiation, coordination, and completion of an international, multi-institution pathology research study. DESIGN.­: Following a tweet describing a hitherto-unreported biopsy-related histologic finding in a mediastinal lymph node following endobronchial ultrasound-guided transbronchial needle aspiration, a tweet was posted to invite pathologists to participate in a validation study. Twitter's direct messaging feature was used to create a group to facilitate communication among participating pathologists. Contributing pathologists reviewed consecutive cases of mediastinal lymph node resection following endobronchial ultrasound-guided transbronchial needle aspiration and examined them specifically for biopsy site changes. Data spreadsheets containing deidentified data and digital photomicrographs of suspected biopsy site changes were submitted via an online file hosting service for central review by 5 pathologists from different institutions. RESULTS.­: A total of 24 pathologists from 14 institutions in 5 countries participated in the study within 143 days of study conception, and a total of 297 cases were collected and analyzed. The time interval between study conception and acceptance of the manuscript for publication was 346 days. CONCLUSIONS.­: To our knowledge, this is the first time that a social media platform has been used to generate a research idea based on a tweet, recruit coinvestigators publicly, communicate with collaborating pathologists, and successfully complete a pathology study.

Dos casos de sarcoma de partes blandas de presentacióninsólita, con dificultades para el diagnóstico (El hombre deEstambul. Una situación bastante habitual: no reconoceruna lesión porque no está en el lugar «adecuado») / Soft tissue sarcoma: 2 cases of unusual presentation and difficult diagnosis. («The man from Istanbul»: a fairly frequent situation in which a lesion is not recognised due to it occurring in an «unexpected»place)

Para un patólogo preparado, reconocer un tumor cuandopresenta la morfología característica y está en su localizaciónhabitual es fácil. Pero cuando se presenta en un lugarinsólito y además la biopsia para diagnóstico es pequeña, esfácil caer en un error de orientación y, aunque a veces lastécnicas auxiliares nos puedan ayudar, en algunas ocasionesno se concreta el diagnóstico hasta que una biopsia completao la extirpación del tumor nos permiten ver la totalidad dela lesión, con la sobrecarga de tiempo, riesgo para el pacientey gasto económico que ello conlleva.El Prof. Rosai describe esta situación con la historia quecontaba Lauren V. Ackerman y que tituló «El hombre deEstambul»: el empecinamiento en no reconocer un tumorporque no está en «su» lugar.Aportamos dos casos de sarcomas de partes blandas quese presentaron en localizaciones que podríamos llamar«invertidas»: un sarcoma sinovial mandibular y un mioepiteliomamaligno yuxtaarticular en un dedo del pie y exponemoslas dificultades que presentaron para su diagnóstico inicial (AU)

A tumour with a characteristic morphological appearanceoccurring in a usual location is easy to diagnose. However,if a tumour is found in an unexpected site and only asmall amount of biopsy material is available, it is more difficultto reach a correct diagnosis.Dr Rosai quotes an expression often used by Lauren V.Ackerman to describe such a situation: «the man from Istanbul», ie. a common lesion occurring in the wrong place.Two cases of common soft tissue tumours located inuncommon places are presented: a synovial sarcoma in themandible and a malignant myoepithelioma (mixed tumour)near the phalangeal joint of the foot. The difficulties of acorrect initial diagnosis are discussed (AU)

Breast core biopsy reporting categories--An internal validation in a series of 3054 consecutive lesions.

We reviewed 3226 consecutive core biopsies (CBs) of 3054 mammographically detected breast lesions performed at our Centre from November 1993 to June 2003. CB diagnoses, classified according to the Non-operative Diagnosis Subgroup of the British National Health Service Breast Cancer Screening Programme (NHSBSP), were B5 (37.1%), B4 (0.5%), B3 (7.6%), B2 (50.9%) and B1 (3.9%). It was necessary to repeat the procedure in 172 cases (5.3%). The values for absolute sensitivity and specificity are 90.8% and 83.8%, respectively. The positive predictive value for categories B4 and B5 is 100%, with no false-positives. The positive predictive value for category B3 is 16.3%. The negative predictive value for B2 category is 97.2%, with a false-negative rate of 3.5%. In conclusion, this system of analysis has enabled us to confirm that our CB results surpass the minimum recommended standards proposed by the NHSBSP.