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Scott Kilpatrick, MD
Director, Orthopedic Pathology Co-Director, ePathology (Digital Pathology). Editorial Board, Human Pathology. Opinions are mine.
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Scott Kilpatrick, MD Nov 18
Somehow I think those nuclear grooves are key to dx. “I know that I am intelligent because I know that I know nothing” Socrates
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Scott Kilpatrick, MD Nov 18
Replying to @JMGardnerMD
Rightly or wrongly I’ve signed these out as “Well differentiated Squamous cell carcinoma with features of keratoacanthoma”. I got this from practice from a mentor Dr Wain White.
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Scott Kilpatrick, MD Nov 15
Thank you Adam!
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Scott Kilpatrick, MD Nov 15
Replying to @ScottBikeethan
About 1/3 show a range of morphologic features, including rosettes/pseudorosettes. Desmin often shows dot-like positivity. In addition to intra-abdominal it has been documented in a variety of locations: bone, sinonasal, liver, spleen, pancreas, intestines, ovaries, and testis.
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Scott Kilpatrick, MD Nov 15
Replying to @ScottBikeethan
But Gerald and Rosai are generally credited with the designation DSRCT. Typically divergent immunotype, neural, myogenic, and epithelial. Less commonly CD99 Very aggressive clinical course. The translocation involving the Wilm tumor gene WT-1 first described in 1992.
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Scott Kilpatrick, MD Nov 15
For those who guessed DSRCT, you are correct. It has the EWSR1-WT1 fusion, or t(11;22)(p13;q12). DSRCT originally described in 1987 by Sesternhenn in J Urol as "Undifferentiated epithelial tumors involving the serosal surfaces of scrotum and abdomen in young males"(17)
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Scott Kilpatrick, MD Nov 15
Replying to @ElhamNasri
Excellent idea and I have another different case that illustrates this point (myoepithelial carcinoma with EWSR1).
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Scott Kilpatrick, MD Nov 15
I agree with this. Favor nerve sheath myxoma, although one could argue plexiform schwannoma. Probably doesn’t matter. NSM and plexiform schwannoma may be a spectrum of a similar neoplasm with similar molecular signatures. Weird degree of atypia/ancient change
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Scott Kilpatrick, MD Nov 14
Replying to @jessicaghaferi
I assume this is superficial, like ulcerated skin, and not adjacent to periosteum?
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Scott Kilpatrick, MD Nov 14
Experience matters. I firmly believe review of outside pathology should always occur at the treating hospital. The cost is small but consequences great if original dx is incorrect.
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Scott Kilpatrick, MD Nov 14
Very nice and very true. Thanks for taking the time to create this video!
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Scott Kilpatrick, MD Nov 14
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Scott Kilpatrick, MD Nov 14
Replying to @brian_odum
Good thought. I’ll tell all tomorrow.
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Scott Kilpatrick, MD Nov 14
Replying to @ElhamNasri
Good thought but myogenin is negative. I’ll tell all tomorrow.
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Scott Kilpatrick, MD Nov 14
Excellent advice and a nice walk down memory lane!
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Scott Kilpatrick, MD Nov 14
Agree with the notion that the immunos don't really fit. CD99 is not diffuse membranous, and there is focal desmin + (see pic below). It has an t(11;22) and a EWSR1 (22q12) rearrangement, but it is NOT Ewing sarcoma. I know all of you know this answer! More later today. Cheers!
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Scott Kilpatrick, MD Nov 13
Thanks to all of you fellow pathologists who make the modern practice of medicine possible by rendering accurate and thoughtful diagnoses and tirelessly working to provide the best possible and timely care for our patients. Wishing all of you the best!😁
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Scott Kilpatrick, MD Nov 13
Replying to @brian_odum
Very nice. Thanks
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Scott Kilpatrick, MD Nov 13
FISH for EWSR1 is + Based on this information, is this Ewing/PNET? What do you need to establish this diagnosis? Do immuno results below fit? We now know it is NOT olf neuroblastoma, although initially in diff dx. Stay tuned....more details tomorrow.....
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Scott Kilpatrick, MD Nov 12
Good case! I always have to remind myself to think about Merkel cell carcinoma. It occasionally sneaks up on us on our soft tissue service and it’s usually a resident or fellow who reminds me to get a CK20.
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