Evaluation of suspected malignancies - Revision history

Mikael Häggström: /* Histopathologic type */ Generally

2024-04-05T12:12:31Z

Histopathologic type: Generally

← Older revision		Revision as of 08:12, 5 April 2024
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	===Further histopathologic subtyping and grading===		===Further histopathologic subtyping and grading===
	Beyond determining overall malignancy diagnosis (such as adenocarcinoma), probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management.		Beyond determining overall malignancy diagnosis (such as adenocarcinoma), probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management, but generally much less so than staging.

	{{Undifferentiated malignancy}}		{{Undifferentiated malignancy}}

Mikael Häggström: /* Molecular workup */ Bolded

2024-02-08T16:10:55Z

Molecular workup: Bolded

← Older revision		Revision as of 12:10, 8 February 2024
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	==Molecular workup==		==Molecular workup==
	Ensure that any cancer undergoes reflex testing where applicable by local guidelines. When they are not applicable, a rule of thumb is to order individual ~~DNA~~ testing ~~for~~ up to 2 genetic targets, and to order genomic sequencing if ~~there are~~ more targets.		Ensure that any cancer undergoes reflex testing where applicable by local guidelines. When they are not applicable, a rule of thumb is to order individual genetic testing if there is a need to test up to 2 genetic targets, and to order genomic sequencing if more targets need genetic testing (not counting [[immunohistochemitry]] or other more easily performed tests).

	When ~~samples need~~ to ~~be sent~~ to an outside laboratory, follow their requirements and guidelines for each test. Generally, choose the tissue block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.		When needing to '''send out''' tissue to an outside laboratory, follow their requirements and guidelines for each test. Generally, choose the tissue block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.

	==Reporting==		==Reporting==

Mikael Häggström: /* Molecular workup */ DNA

2024-02-08T16:08:32Z

Molecular workup: DNA

← Older revision		Revision as of 12:08, 8 February 2024
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	==Molecular workup==		==Molecular workup==
	Ensure that any cancer undergoes reflex testing where applicable by local guidelines. When they are not applicable, a rule of thumb is to order individual testing for up to 2 genetic targets, and to order genomic sequencing if there are more targets.		Ensure that any cancer undergoes reflex testing where applicable by local guidelines. When they are not applicable, a rule of thumb is to order individual DNA testing for up to 2 genetic targets, and to order genomic sequencing if there are more targets.

	When samples need to be sent to an outside laboratory, follow their requirements and guidelines for each test. Generally, choose the tissue block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.		When samples need to be sent to an outside laboratory, follow their requirements and guidelines for each test. Generally, choose the tissue block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.

Mikael Häggström: /* Molecular workup */ Rule of thumb

2024-02-08T16:07:36Z

Molecular workup: Rule of thumb

← Older revision		Revision as of 12:07, 8 February 2024
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	==Molecular workup==		==Molecular workup==
	Ensure that any cancer undergoes reflex testing where applicable by local guidelines. ~~Send~~ samples ~~according~~ to requirements and guidelines for each test. Generally, choose the block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.		Ensure that any cancer undergoes reflex testing where applicable by local guidelines. When they are not applicable, a rule of thumb is to order individual testing for up to 2 genetic targets, and to order genomic sequencing if there are more targets.

			When samples need to be sent to an outside laboratory, follow their requirements and guidelines for each test. Generally, choose the tissue block with the greatest amount/area of the highest grade malignancy. For molecular proliferation tests (other than [[immunohistochemistry]]) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rates). On the other hand, for next-generation sequencing, hemorrhage, necrosis and adipose tissue does not need to be minimized, as these contain only little genetic material.

	==Reporting==		==Reporting==

Mikael Häggström: /* Staging */ Uncertain

2024-02-08T15:31:27Z

Staging: Uncertain

← Older revision		Revision as of 11:31, 8 February 2024
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	\|}		\|}
	[[File:Histopathology of a lymph node with metastatic invasive ductal carcinoma from the breast.jpg\|thumb\|220px\|For positive lymph nodes, generally also note any '''extranodal extension''', and the size thereof.]]		[[File:Histopathology of a lymph node with metastatic invasive ductal carcinoma from the breast.jpg\|thumb\|220px\|For positive lymph nodes, generally also note any '''extranodal extension''', and the size thereof.]]
	Put your main '''focus''' on features that will determine the final stage. For example, if you see a lymph node involved by cancer, the presence or absence of lymphatic invasion is no longer critical, but rather the presence or absence of additional involved nodes or distant metastasis.		Put your main '''focus''' on features that will determine the final stage. For example, if you see a lymph node involved by cancer, the presence or absence of lymphatic invasion is no longer critical, but rather the presence or absence of additional involved nodes or distant metastasis. If a stage-defining finding is uncertain, generally fall back to the lower stage.

	For the '''size''', the greatest dimension of the tumor is most important. Second and third dimensions (preferably at right angles compared to each other) are optional. Use the largest measure for each dimension. For example if one slide shows a tumor measuring 2.0 x 1.0 cm, and another slide shows the same tumor measuring 1.5 x 1.5 cm, then the tumor can be reported as measuring 2.0 x 1.5 cm. The third dimension can be estimated from gross measurement, or, if the tumor is entirely submitted, adding together the presumed thickness of each slice where tumor is found microscopically. For excisions with less than a centimeter of tumor, and where there has been a previous biopsy, consider looking at the size of tumor on the previous biopsy, which may be the largest measurement, and therefore the measurement of choice for staging.		For the '''size''', the greatest dimension of the tumor is most important. Second and third dimensions (preferably at right angles compared to each other) are optional. Use the largest measure for each dimension. For example if one slide shows a tumor measuring 2.0 x 1.0 cm, and another slide shows the same tumor measuring 1.5 x 1.5 cm, then the tumor can be reported as measuring 2.0 x 1.5 cm. The third dimension can be estimated from gross measurement, or, if the tumor is entirely submitted, adding together the presumed thickness of each slice where tumor is found microscopically. For excisions with less than a centimeter of tumor, and where there has been a previous biopsy, consider looking at the size of tumor on the previous biopsy, which may be the largest measurement, and therefore the measurement of choice for staging.

Mikael Häggström: /* Gland-like tumors */ 7

2024-01-24T22:39:09Z

Gland-like tumors: 7

← Older revision		Revision as of 18:39, 24 January 2024
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	:*[[Endometrial adenocarcinoma]]		:*[[Endometrial adenocarcinoma]]
	:*[[Pancreatic ductal adenocarcinoma]]		:*[[Pancreatic ductal adenocarcinoma]]
	[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|~~300px~~\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]		[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|370px\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]
	Generally, adenocarcinomas are categorized by degree of '''differentiation''' as follows:		Generally, adenocarcinomas are categorized by degree of '''differentiation''' as follows:
	*Well differentiated: > 95% of tumor has glandular formations		*Well differentiated: > 95% of tumor has glandular formations

Mikael Häggström: /* Gland-like tumors */ '''

2024-01-24T21:47:11Z

Gland-like tumors: '''

← Older revision		Revision as of 17:47, 24 January 2024
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	*Moderately differentiated: 50 - 95% glandular		*Moderately differentiated: 50 - 95% glandular
	*Poorly differentiated: < 50% glandular		*Poorly differentiated: < 50% glandular
	If [[Metastasis\|metastatic]] adenocarcinoma seems to be the case (always consider this in at least [[lung adenocarcinoma]]), look at the history and radiology reports for a most likely primary. Generally, perform [[immunohistochemistry]] with one or two stains that are most typical for the suspected primary, and optionally add CK7 and CK20 as a broad screening. {{further\|Metastasis}}		If '''[[Metastasis\|metastatic]] adenocarcinoma''' seems to be the case (always consider this in at least [[lung adenocarcinoma]]), look at the history and radiology reports for a most likely primary. Generally, perform [[immunohistochemistry]] with one or two stains that are most typical for the suspected primary, and optionally add CK7 and CK20 as a broad screening. {{further\|Metastasis}}

	===Squamoid tumors===		===Squamoid tumors===

Mikael Häggström: /* Gland-like tumors */ Metastatic

2024-01-24T21:45:28Z

Gland-like tumors: Metastatic

← Older revision		Revision as of 17:45, 24 January 2024
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	:*[[Pancreatic ductal adenocarcinoma]]		:*[[Pancreatic ductal adenocarcinoma]]
	[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|300px\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]		[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|300px\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]
	Generally, adenocarcinomas are categorized by degree of differentiation as follows:		Generally, adenocarcinomas are categorized by degree of '''differentiation''' as follows:
	*Well differentiated: > 95% of tumor has glandular formations		*Well differentiated: > 95% of tumor has glandular formations
	*Moderately differentiated: 50 - 95% glandular		*Moderately differentiated: 50 - 95% glandular
	*Poorly differentiated: < 50% glandular		*Poorly differentiated: < 50% glandular
			If [[Metastasis\|metastatic]] adenocarcinoma seems to be the case (always consider this in at least [[lung adenocarcinoma]]), look at the history and radiology reports for a most likely primary. Generally, perform [[immunohistochemistry]] with one or two stains that are most typical for the suspected primary, and optionally add CK7 and CK20 as a broad screening. {{further\|Metastasis}}

	===Squamoid tumors===		===Squamoid tumors===

Mikael Häggström: /* Gland-like tumors */ Size

2024-01-19T23:22:19Z

Gland-like tumors: Size

← Older revision		Revision as of 19:22, 19 January 2024
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	:*[[Endometrial adenocarcinoma]]		:*[[Endometrial adenocarcinoma]]
	:*[[Pancreatic ductal adenocarcinoma]]		:*[[Pancreatic ductal adenocarcinoma]]
	[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]		[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|300px\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]
	Generally, adenocarcinomas are categorized by degree of differentiation as follows:		Generally, adenocarcinomas are categorized by degree of differentiation as follows:
	*Well differentiated: > 95% of tumor has glandular formations		*Well differentiated: > 95% of tumor has glandular formations

Mikael Häggström: /* Gland-like tumors */ ]]

2024-01-19T22:44:21Z

Gland-like tumors: ]]

← Older revision		Revision as of 18:44, 19 January 2024
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	:*[[Endometrial adenocarcinoma]]		:*[[Endometrial adenocarcinoma]]
	:*[[Pancreatic ductal adenocarcinoma]]		:*[[Pancreatic ductal adenocarcinoma]]
	[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|Degree of differentiation, with example from a [[colorectal adenocarcinoma.]]		[[File:Well-, moderately and poorly differentiated colorectal adenocarcinoma.png\|thumb\|Degree of differentiation, with example from a [[colorectal adenocarcinoma]].]]
	Generally, adenocarcinomas are categorized by degree of differentiation as follows:		Generally, adenocarcinomas are categorized by degree of differentiation as follows:
	*Well differentiated: > 95% of tumor has glandular formations		*Well differentiated: > 95% of tumor has glandular formations