MARCH 2017 # 28 Upfront In My View In Practice Profession The nose knows when Blurred research boundaries The patient’s perspective on A pathology school for it comes to lung cancer require organizational change medical research trainees with limited access 10 14 – 15 34 – 37 48 – 49 Pathology on a Shoestring How can we provide the best care in settings with the fewest resources? 18 – 31 www.thepathologist.com The first-ever, two-in-one, seven-color Say hello to the first multi-modal, digital pathology instrument that integrates both multispectral multispectral analysis and automated slide scanning. Vectra® Polaris™ better visualizes, analyses, quantifies, imaging system and phenotypes immune cells in situ in FFPE tissue sections and digital and TMAs so you can unlock the promise of precision medicine. whole-slide Phenoptics™ Quantitative Pathology Research Solution scanner. A www.perkinelmer.com/Phenoptics powerful world class series. The first-ever, two-in-one, Case seven-color Say hello to the first multi-modal, of the digital pathology instrument that integrates both multispectral Month multispectral analysis and automated slide scanning. Vectra® Polaris™ better visualizes, analyses, quantifies, imaging system and phenotypes immune cells Urinary bladder tumor in situ in FFPE tissue sections The tumor shown here was removed by and digital and TMAs so you can unlock the radical cystectomy from a 72-year-old man. promise of precision medicine. The tumor cells were positive for cytokeratin 7 and weakly positive for CD138, but were negative for immunoglobulins and mucins. whole-slide Phenoptics™ Quantitative Pathology Research Solution What is the most likely diagnosis? Urothelial carcinoma scanner. A www.perkinelmer.com/Phenoptics A Adenocarcinoma of powerful world B urachal origin C Plasmacytoma class series. D Plasmacytoid carcinoma E Metastatic breast carcinoma Do you think you have a good case of the Credit: Ivan Damjanov, Kansas Club Histopathology Damjanov, Ivan Credit: month? Email it to [email protected] To register your guess, please go to http://tp.txp.to/0317/case-of-the-month We will reveal the answer in next month’s issue! markers, such as microphthalmia transcription factor, Melan A, and HMB45, and Answer to last month’s Case of the Month… C: Malignant perivascular epithelioid cell tumor (PEComa) smooth muscle cell markers, such as smooth muscle actin or calponin. Desmin and PEComas are soft tissue tumors composed of nests of clear or granular eosinophilic S100 are less often positive (1). cells that have the immunohistochemical features of perivascular epithelioid Submitted by Wei Cui, The University of Kansas School of Medicine, Kansas cells. These cells may be epithelioid- or spindle-shaped. The tumor nests are City, Kansas, USA. typically surrounded by capillary vessels. Typical PEComas may show occasional pleomorphism, but mitotic figures are usually rare or absent. Malignant PEComas Reference are characterized by brisk mitotic activity, necrosis, marked nuclear atypia, and 1. JL Hornick, CC Pan, “PEComas”, WHO classification of tumours of soft tissue significant pleomorphism as in this case. Tumor cells are positive for melanoma and bone. IARC Press: 2013. www.thepathologist.com Contents 10 In My View 14 Giorgio Stanta questions whether the ongoing approach to clinical and translational research is the best way forward. 15 Unlocking the intricacies of the microbiome could unveil novel diagnostic and therapeutic targets. Liam Heaney explains how analytical science can allow 18 us to do so. 16 Is there a better way to diagnose malignant mesothelioma? Anders Hjerpe believes there is, and that 03 Case of The Month Upfront the answer lies with cytology. 08 The Castleman Criteria 07 Editorial Everything’s Bigger in Texas, 09 FOSL1 Fuel Feature by Fedra Pavlou 10 Sticking Our Noses into 18 Pathology on a Shoestring Lung Cancer Low- and middle-income regions often don’t have the On The Cover 11 DESNT: Poor Prognosis right tools to best serve their MARCH 2017 # 28 Prostate Cancer populations. We highlight Upfront In My View In Practice Profession The nose knows when Blurred research boundaries The patient’s perspective on A pathology school for it comes to lung cancer require organizational change medical research trainees with limited access 10 14 – 15 34 – 37 48 – 49 A microscope constructed from cheap, portable devices that Pathology on a Shoestring How can we provide the best care in settings with the fewest resources? 18 – 31 cardboard, representing low-cost 12 Cancer Comes Unglued provide pathologists and labs tools for developing regions. with the means to aid patients www.thepathologist.com 13 Cracking the Case of Crohn’s more efficiently. ISSUE 28 - MARCH 2017 Editor - Fedra Pavlou [email protected] Deputy Editor - Michael Schubert [email protected] Associate Editor - William Aryitey [email protected] Content Director - Rich Whitworth [email protected] Publisher - Mark Goodrich [email protected] Head of Design - Marc Bird [email protected] Designer - Emily Strefford-Johnson [email protected] Junior Designer - Hannah Ennis 40 [email protected] Digital Team Lead - David Roberts [email protected] Digital Producer Web/Email - Peter Bartley [email protected] 48 50 Digital Producer Web/App - Abygail Bradley [email protected] Digital Content Assistant - Lauren Torr [email protected] Audience Insight Manager - Tracey Nicholls [email protected] Traffic and Audience Associate - Lindsey Vickers [email protected] Traffic and Audience Associate - Jody Fryett [email protected] Social Media / Analytics Associate - Ben Holah [email protected] Events and Office Administrator - Alice Daniels-Wright [email protected] Financial Controller - Phil Dale In Practice [email protected] Chief Executive Officer - Andy Davies [email protected] 34 The Missing Piece of the Puzzle Chief Operating Officer - Tracey Peers Marleen Kaatee illustrates why [email protected] patients should be an integral part of the research process, and Profession Change of address: how better communication with [email protected] Tracey Nicholls, The Pathologist, them can benefit everyone. 48 The School of Life Texere Publishing Ltd, Haig House, Haig Road, To expand education and Knutsford, Cheshire, WA16 8DX, UK resources for pathology trainees General enquiries: www.texerepublishing.com in Eastern Europe, Semir [email protected] +44 (0) 1565 745200 NextGen Vranić and his colleagues took [email protected] on a novel initiative – the Bryan 40 Three Gurus of Big Data Warren School of Pathology. Distribution: As we wade through the The Pathologist (ISSN 2055-8228) and The Pathologist North America (ISSN 2514-4049), mounting quantity of scientific is published monthly by Texere Publishing data, are we fully utilizing its Ltd and is distributed in the USA by UKP Worldwide, 1637 Stelton Road B2, capabilities? Dipak Kalra, Iain Sitting Down With Piscataway, NJ 08854. Periodicals Postage Paid at Piscataway, Buchan, and Norman Paton NJ and additional mailing offices discuss the ins and outs of big 50 Mark Boguski, Senior Vice POSTMASTER: Send US address changes to The Pathologist, Texere Publishing Ltd, C/o data and how it can affect the President for Precision 1637 Stelton Road B2, Piscataway NJ 08854 Single copy sales £15 (plus postage, cost available biomedical future. Medicine, Inspirata. on request [email protected]) Annual subscription for non-qualified recipients £110 Reprints & Permissions – [email protected] Everything’s Bigger in Texas Editorial ... including the welcome. But meeting you – our readers – was the real highlight in San Antonio s I write this editorial, I am just about shaking off the desynchronosis from yet another fantastic USCAP event – this year, held in the wonderful city of San AAntonio, Texas. I can’t emphasize how pleased I was to meet so many of you there; the feedback I received was simply amazing! (And, I’ll be honest, I was happy that my boss was there to hear some of the praise...) A big thanks goes out to all of you who stopped by our stand to let us know what you think of The Pathologist and, in one (slightly reluctant) case, to sign a copy of a Sitting Down With for a fan (...you know who you are, Jerad Gardner!). One item that seems to have gone down well is our relatively new reader-requested section, Case of the Month. In fact, someone told me that January’s case was the subject of a lengthy conversation between a group of people at an evening event during the USCAP congress. That conversation then led to a direct connection between a person at the event and the submitter of the case – and I believe those people are now discussing a potential informal collaboration! My sincere thanks to Ivan Damjanov for getting this initiative up and running. I urge the rest of you to get involved. If you think you’ve got a case that may stump your peers, please email us. If we feel it’s strong or curious enough (and assuming you have a high- resolution image), we’ll publish it and let you know how many of our readers got it right. I hope Case of the Month demonstrates our commitment to listening to our readers. On that note,