Anatomic Pathology Selected Abstracts, 3/14

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Anatomic pathology abstracts editors: Michael Cibull, MD, professor of pathology, University of Kentucky, Lexington; Rouzan Karabakhtsian, MD, attending pathologist, Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Thomas Cibull, MD, dermatopathologist, Evanston Hospital, NorthShore University HealthSystem, Evanston, Ill.; and Rachel Stewart, DO, resident physician, Department of Pathology and Laboratory Medicine, University of Kentucky.

Use of morphological parameters of LN in stereotactic 11-gauge vacuum-assisted needle core biopsy

Management of lobular in situ neoplasia when diagnosed on core biopsy remains controversial. The authors conducted a study to investigate the association between morphological parameters of lobular in situ neoplasia (LN) on vacuum-assisted needle core biopsy (VANCB) and the presence of malignancy (ductal carcinoma in situ, pleomorphic lobular carcinoma in situ, or invasive carcinoma) at surgical excision. The study included 14 pathology departments in Italy. Available slides from 859 cases of VANCB reporting an original diagnosis of flat epithelial atypia, atypical ductal hyperplasia, or LN, all with subsequent surgical excision, were reviewed. Overall, 286 cases of LN, pure or associated with other lesions, were identified, and a malignant outcome was reported at excision for 51 cases (17.8 percent). Among the 149 cases of pure LN, an increased risk of malignancy emerged in women in mammographic categories R4–R5 as compared with those in categories R2–R3 (OR, 2.46; P=0.048). In the series, a statistically significant decreased malignancy risk emerged among cases without determinant microcalcifications (P=0.04). The authors concluded that their results suggest that the diagnosis of pure LN on VANCB warrants followup excision because clinicopathological parameters do not allow the prediction of which cases will present carcinoma at surgical excision.

Bianchi S, Bendinelli B, Castellano I, et al; for VANCB Study Group. Morphological parameters of lobular in situ neoplasia in stereotactic 11-gauge vacuum-assisted needle core biopsy do not predict the presence of malignancy on subsequent surgical excision. Histopathology. 2013;63:83–95.

Correspondence: S. Bianchi at simonetta.bianchi@unifi.it

Outcome of pure MLL without atypia diagnosed on needle core biopsy

Guidelines recommend that mucocele-like lesions of the breast diagnosed on needle core biopsy be categorized as a lesion of uncertain malignant potential (B3). However, data on the outcome of mucocele-like lesions (MLL) diagnosed on needle core biopsy remain limited due to the rarity of the lesion. The authors conducted a study to assess the outcome of pure MLL without atypia diagnosed on needle core biopsy using a large series of cases and a review of the literature to provide evidence that can guide management. Patients who underwent diagnostic excision biopsy after a core biopsy diagnosis of MLL without atypia were identified from several medical centers. Two of 54 patients (four percent) with MLL without atypia on core biopsy had ductal carcinoma in situ in the subsequent excision specimen. This is similar to the rate in previous studies (four percent; four of 106). Previous studies found that when there is atypia in the core biopsy, the frequency of malignancy is much higher (21 percent; seven of 33). The authors concluded that their results provide evidence that pure MLL without atypia diagnosed on needle core biopsy is usually associated with a benign outcome.

Rakha EA, Shaaban AM, Haider SA, et al. Outcome of pure mucocele-like lesions diagnosed on breast core biopsy. Histopathology. 2013;62:894–898.

Correspondence: E. A. Rakha at emadrakha@yahoo.com

Perineural invasion in T1 oral squamous cell carcinoma and aggressive elective neck dissection

Observation versus elective neck dissection for cN0 neck is controversial for the treatment of T1-2 oral squamous cell carcinoma (OSCC). Perineural invasion has been recognized as a poor prognostic factor for OSCC. However, its significance in T1 OSCC remains unclear. A detailed histologic re-evaluation of perineural invasion was carried out in 307 patients with T1-2 OSCC who underwent surgical treatment between June 2001 and January 2009. The authors found that perineural invasion correlated with cervical lymph node metastasis in T1 and T2 OSCC, with a lower perineural invasion-positive rate in T1 (17.1 percent versus 36.6 percent; P<0.001). Importantly, observation for cN0 neck was used twice as often in T1 as in T2 patients (47.4 percent versus 22.8 percent; P<0.001). Although patients with T1 OSCC achieved significantly better outcomes, perineural invasion correlated with neck recurrence and poor disease-specific survival in T1 (P

Tai SK, Li WY, Yang MH, et al. Perineural invasion in T1 oral squamous cell carcinoma indicates the need for aggressive elective neck dissection. Am J Surg Pathol. 2013;37(8):1164–1172.

Correspondence: S. K. Tai at sktai@vghtpe.gov.tw