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316A ANNUAL MEETING ABSTRACTS Results: IPMC involved >5% of villi in 11 of 17 placentas (65%) from FD cases, but Immunohistochemical study showed consistent loss of PAX2 nuclear staining in 100% only 1 of 118 from live births (0.8%, p<0.0001). IPMC involved >10% of villi in 5 of cases regardless of endocervical-type or gastrointestinal-type. All cases showed positive 17 placentas (30%) from FD cases and none from live births (0%, p<0.0001). Clinical PAX8 staining and wild-type p53 staining pattern including those of gastrointestinal data for 11 of the 17 FD cases was available. IPMC in >5% of villi were seen in 3 of type. ER was diffuse (>70%) and strong in eleven cases (85%), focal and moderate the 7 cases where fetus was delivered within 1 day, versus 4 of 4 cases where fetus in two cases. PR was negative in six cases, focal and moderate in four cases, diffuse was retained for >1 days after demise (p<.05). Frequency of IPMC in categories other and strong (>70%) in three cases. P16 was either negative (5) or focally positive (8). than fetal demise are shown in table 1. Conclusions: Pure EMC is diagnostically challenging due to its bland histologic features. Our study demonstrates that loss of PAX2 staining was observed in all cases Percentage of Post Term IUGR Chronic Chorioamnionitis GDM (n=20), regardless of endocervical or gastrointestinal cell type. Retaining strong ER expression Villi involved Births (n=15), Villitis (n=19), n(%) n(%) by IPMC (%) (n=12), n(%) n(%) (n=15), n(%) and variable loss of PR expression occurred in most pure EMC (77%). A panel of immunostains including PAX2, ER and PR can help identify EMC in problematic <1 10(50) 12(60) 5(42) 9(60) 8(53) biopsy/curetting specimens. 1-5 6(30) 6(30) 2(17) 3(20) 2(13) 5-10 1(6) 1257 Pattern C Invasive Endocervical Adenocarcinomas: Can We Identify >10 the More Aggressive Subset? None 3 2 3 3 4 Ranran Zhang, Erin E Medlin, Paul S Weisman, Ahmed Al-Niaimi, Aparna Mahajan. University of Wisconsin Hospital and Clinics, Madison, WI. Figures 1 and 2: IPMC in the basement membranes of villi with perivillous fibrin and Background: A recently proposed classification for endocervical adenocarcinoma (EA) within the perivillous fibrin (1A and 1B). However, IPMC were also present in otherwise has shown that the vast majority of EAs with lymph node metastases (LNM) and/or seemingly normal villi, without any perivillous fibrin (2A). recurrences display a frankly invasive pattern (pattern C). However, even in pattern C tumors, LNM are seen in less than a quarter of cases (24%) and the factors that predict aggressive behavior in this group remain unclear. Design: All available resections of usual type EA with negative margins at our institution from 2002-2014 were retrieved. Other histologic subtypes were excluded. Pattern C assignment required agreement by 2 pathologists (AM, PSW). Tumors were stratified as follows: Greatest horizontal extent (GHE) <1 cm vs ≥ 1cm; depth of invasion (DOI) <1 cm vs ≥ 1cm; % cervical wall invasion (CWI) <50% vs ≥50%; presence of lymphovascular invasion (LVI); and presence of microcystic, elongated, and fragmented pattern invasion (MELF). LNM and recurrence data were recorded. Statistical analysis utilized the 2-tailed Fisher’s exact test. Results: 44 cases of EA were available. 14 cases of other histologic subtypes were excluded, leaving 30 cases of usual type EA (15 pattern A or B, 15 pattern C). LN dissection had been performed in all pattern C cases and in 13/15 pattern A or B cases. All LNM (2 cases) and recurrences (2 cases) occurred in pattern C cases. Among pattern C cases, 11/15 (73%) had GHE ≥ 1cm, 6/15 (40%) had DOI ≥ 1cm, 10/15 (67%) had %CWI ≥50%, 3/15 (20%) had LVI, and 10/15 (67%) had MELF. While all 4 cases with LNM and/or recurrences had GHE ≥ 1cm, CWI ≥50%, and MELF, none of these trends reached statistical significance [GHE ≥ 1cm (4/11 vs 0/4, p = 0.52); CWI ≥50% (4/10 vs 0/5, p = 0.23); MELF (4/10 vs 0/5, p = 0.23)]. Conclusions: While limited by its small size, our study demonstrates that large tumor volume (≥ 1cm GHE), invasion into the outer aspect of the cervix (≥50% CWI), and MELF are frequent findings in pattern C tumors with LNM and/or recurrence. Larger studies are required to determine if these features can reliably predict which pattern C tumors are more likely to run an aggressive clinical course. Head and Neck Pathology 1258 Sinonasal leiomyosarcoma: Analysis of 9 Cases Exploring Their Clinicopathological and Morphological Spectrum with Emphasis on Previous Irradiation and Association with Other Malignancies Abbas Agaimy, Sarina Muller, Lester DR Thompson. University Hospital of Erlangen, Erlangen, Germany; Woodland Hills Medical Center, Woodland Hills, CA. Background: Sinonasal tract leiomyosarcoma is exceedingly rare with less than 100 Conclusions: Association of IPMC with fetal demise, duration of fetal demise and cases reported. Their exact pathogenesis remains unknown and their relationship to perivillous fibrin suggests that IPMC may be a response to a local hypoxic environment. retinoblastoma and previous irradiation has not been specifically explored. Presence of IPMC in more than 10% of villi may be used to support a diagnosis of Design: Routine and consultation cases were reviewed for histologically and intrauterine fetal demise in forensic and medico-legal cases. immunohistochemically proven sinonasal leiomyosarcomas. The tumors were tested with antibodies directed against alpha smooth muscle actin, desmin, h-caldesmon, HMB45, Rb1 and MDM2. 1256 Immunohistochemical Profile of Pure Endometrial Mucinous Results: The 9 cases included 5 males and 4 females aged 26 to 77 years (median: Adenocarcinoma 48 years). Tumor sites were maxillary sinus (n=4), nasal cavity (n=3) and combined Gloria Zhang, Charles V Biscotti, Tao Wu, Xiangdong Ding, Bin Yang. Cleveland Clinic, nasal and sinuses (n=2). Three patients had previous irradiation (2 for retinoblastoma, Cleveland, OH; Kingmed Diagnostics, Guangzhou, OH. 1 for fibrous dysplasia) and another patient had chemotherapy and stem cell Background: Most endometrial mucinous carcinomas (EMC) have a major mucinous transplantation for Hodgkin lymphoma. All patients with follow-up developed either component (>50%) and minor endometrioid component. Pure EMC occurs rarely. local recurrences or/and metastases, mainly to lung (time to metastasis: 16-55 months). EMC’s deceptively bland histopathologic features with low grade nuclear atypia Histologically, all tumors but one were conventional high-grade leiomyosarcomas complicate recognition particularly in endometrial biopsy /curetting specimens. We indistinguishable from their somatic soft tissue counterparts; one of these had a analyzed the clinicopathologic and immunohistochemical features of a series of pure glycogen-rich clear cell (PEComa-like) morphology. The low-grade primary tumor, EMC. showed grade 2 features in the recurrence and grade 3 features in the lung metastases. Design: Seventeen cases of pure EMC (>95% neoplastic mucinous component), Two cases showed dedifferentiation to anaplastic pleomorphic (MFH-like) phenotype. including 8 in-house and 9 consultation cases, were identified from pathology database. Immunohistochemistry (IHC) showed strong diffuse expression for at least two smooth These included 17 biopsies/currettings and 10 hysterectomy specimens. 13 cases had muscle markers and no reactivity for HMB45. None of the cases expressed MDM2. tissue blocks available for immunostaining with PAX2, PAX8, ER, PR, p16, p53. Ten RB1 IHC showed inconsistent pattern. cases of benign endometrium and benign endocervix served as controls. Conclusions: Sinonasal tract leiomyosarcomas are rare aggressive sarcomas that Results: Patients’ age ranged from 50 to 81 years (mean 59). Thireen patients including frequently develop in a background of previous cancer therapy, often radiation for 4 with voluminous mucinous discharge had abnormal uterine bleeding. Histologically, retinoblastoma. The frequency of leiomyosarcoma in this particular clinical setting fifteen cases (88%) were FIGO 1 and two cases were FIGO 2. Fourteen cases (82%) merits further genetic analysis to identify tumors that are Rb1-derived. A history of had endocervical-type mucinous glands including three cases with a predominant irradiation might have been a confounding factor preventing recognition of hereditary microglandular pattern. Three cases (18%) consisted of either gastric or intestinal-type leiomyosarcoma in the setting of retinoblastoma syndrome. mucinous glands. All 17 cases had mild to moderate cytologic atypia with minimal or no mitotic activity. Subsequent hysterectomy specimens were available in 10 cases. Six tumors lacked myometrial invasion, 2 tumors invaded 1/3 of the myometrial thickness and 2 tumors had deeper myometrial invasion (85% and 90% respectively). ANNUAL MEETING ABSTRACTS 317A 1259 Cutaneous Leishmaniasis Presenting as Facial Midline Lesions: mutations were seen in 10% of AciCC. Other GA identified at 4% frequency included A Series of 15 Cases NCOR1, ARID2, ATM, BCOR, ETV6, FBXW7 and HRAS. Among the CRGA, alterations Elie Alam, Ossama Abbas, Roger Moukarbel, Ibrahim Khalifeh. American University in NF1, PIK3CA and BRAF were found in 1 (2%) AciCC each. The NF1 and PIK3CA of Beirut Medical Center, Beirut, Lebanon. GA open consideration for MTOR pathway inhibitors. The single case of AciCC with Background: Midline destructive lesions of the face (MDL) have a wide range of a BRAF GA featured a BRAF kinase domain duplication in an advanced parotid AciCC, etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause. which developed in a 38 year old woman that did not respond to conventional treatment, Design: The clinical data, biopsies/scrapings and PCR were collected/performed on but achieved a sustained major clinical response to the anti-BRAF drug regorafenib. patients with solitary CL nose lesions (n=15). Ridley’s Pattern (RP) and Parasitic Index Conclusions: The generally low frequency of GA at 2.28 per tumor reflects the slow (PI) were documented.
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  • A Brief History of Head and Neck Pathology Developments☆,☆☆, Lester D.R

    A Brief History of Head and Neck Pathology Developments☆,☆☆, Lester D.R

    Human Pathology (2020) 95,1–23 www.elsevier.com/locate/humpath Progress in pathology Don't stop the champions of research now: a brief history of head and neck pathology developments☆,☆☆, Lester D.R. Thompson MD a,⁎, James S. Lewis Jr. MD b, Alena Skálová MD, PhD c, Justin A. Bishop MD d aSouthern California Permanente Medical Group, Department of Pathology, Woodland Hills, CA 91365, USA bDepartment of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA cSikl's Department of Pathology, Medical Faculty of Charles University, Faculty Hospital, 305 99 Plzen, Czech Republic dDepartment of Pathology, University of Texas Southwestern Medical Center, Clements University Hospital, Dallas, TX 75390, USA Received 13 August 2019; accepted 14 August 2019 Keywords: Summary The field of head and neck pathology was just developing 50 years ago but has certainly come a Head and neck; long way in a relatively short time. Thousands of developments in diagnostic criteria, tumor classification, Salivary gland neoplasms; malignancy staging, immunohistochemistry application, and molecular testing have been made during this Oropharyngeal; time, with an exponential increase in literature on the topics over the past few decades: There were 3506 ar- Pathology; ticles published on head and neck topics in the decade between 1969 and 1978 (PubMed source), with a Immunohistochemistry; staggering 89266 manuscripts published in the most recent decade. It is daunting and impossible to narrow Paranasal sinus neoplasms; the more than 162000 publications in this field and suggest only a few topics of significance. However, the Molecular breakthrough in this anatomic discipline has been achieved in 3 major sites: oropharyngeal carcinoma, sal- ivary gland neoplasms, and sinonasal tract tumors.