August 30, 2008

A Review of Articles From Last Month’s Archives of Pathology & Laboratory Medicine

By Anonymous

Listed below are questions based on articles that appeared in last month's edition of the ARCHIVES. Registered continuing medical education participants should answer these questions either online or use the August 2008 answer sheet. 1. Which of the following statements concerning Rosai-Dorfman disease is false?

a. pulmonary involvement is rare and occurs in approximately 2% to 3% of cases with extranodal disease

b. lymphocytes within histiocyte cytoplasm, termed lymphophagocytosis or emperipolesis, is a distinctive feature of Rosai-Dorfman disease

c. chemotherapy has been shown to provide a marked benefit in most Rosai-Dorfman patients and is considered a primary treatment option

d. most cases of Rosai-Dorfman disease limited to nodal disease exhibit spontaneous resolution

e. the characteristic bilateral and symmetric osteosclerosis of long bones present with Erdheim-Chester disease is helpful in differentiating it from Rosai-Dorfman disease

(from Pulmonary Langerhans Cell Histiocytosis and Other Pulmonary Histiocytic Diseases-Allen)

2. Inflammatory myofibroblastic tumors can occur at any age, although most occur in patients younger than 40 years old, and this tumor is the most common endobronchial mesenchymal lesion reported in childhood.

True or False?

(from Pulmonary Sarcomatous Tumors-Litzky)

3. When discussing the use of immunohistochemical stains in the evaluation of pulmonary and pleural neoplasms, which of the following statements is false?

a. in the clinical setting of a lung mass otherwise typical of a lung primary, a negative keratin stain in a small biopsy specimen does not definitively exclude a sarcomatoid carcinoma

b. neuron-specific enolase, chromogranin, and synaptophysin are all highly specific markers used to discriminate small cell lung carcinoma (SCLC) from non-small cell lung carcinoma (NSCLC)

c. thyroid transcription factor 1 (TTF-1) will stain the majority of SCLCs and large cell neuroendocrine carcinomas, while most typical carcinoids and atypical carcinoids are negative

d. surfactant markers are positive in about 50% of pulmonary adenocarcinomas and are a useful discriminatory marker but overall are not as sensitive as TTF-1

e. features that might suggest a diagnosis of NSCLC rather than SCLC include the presence of more than occasional macronucleoli and abundant cytoplasm with rigid cell borders

(from Immunohistochemistry of Pulmonary and Pleural Neoplasia- Beasley)

4. MALT lymphoma of the lung and nodular lymphoid hyperplasia of the lung both exhibit a lymphangitic growth pattern and have a tendency to spread to the pleura in a plaquelike manner, as well as invade the bronchial cartilage.

True or False?

(from Avoiding Underdiagnosis, Overdiagnosis, and Misdiagnosis of Lung Carcinoma-Butnor)

5. Among the primary and metastatic lung tumors found in the pediatric population, which of the following statements concerning tumors is true?

a. pleuropulmonary blastoma type III includes both solid and cystic lesions that are most often diagnosed in infancy

b. rhabdomyosarcoma is the most common malignancy of the chest wall in children

c. squamous cell carcinoma seems to account for a smaller proportion of lung carcinoma cases in adults (12%) relative to children (35%-50%)

d. mucoepidermoid carcinoma (MEC) represents about 20% of malignant lung neoplasms in children and the 5-year survival rate of children with MEC is 88%

e. adenoid cystic carcinoma has a higher likelihood of distant metastasis compared with MEC and has poorer survival

(from Primary and Metastatic Lung Tumors in the Pediatric Population-Dishop & Kuruvilla)

6. Cells in micronodular pneumocyte hyperplasia usually have a greater degree of nuclear atypia and higher nuclear/ cytoplasmic ratio than in atypical adenomatous hyperplasia.

True or False?

(from Pulmonary Preneoplasia-Dacic)

Copyright College of American Pathologists Aug 2008

(c) 2008 Archives of Pathology & Laboratory Medicine. Provided by ProQuest LLC. All rights Reserved.