ASCP 2018: Broad Differentials, Tiny Specimens

Sep 04, 2018

By John B. Wojcik, MD, PhD, FASCP, and John S. J. Brooks, MD, MASCP

Soft tissue pathology tumors can produce substantial anxiety for the non-subspecialist. We know this from the examination of our own consultation and outside referral services. This is a function of the unfamiliarity of soft tissue tumors, the broad differential diagnoses and the significant morphologic overlap between entities. Moreover, when such differential diagnoses contain both benign and malignant entities, the general surgical pathologist is wise to seek expert consultation since the ramifications of a misdiagnosis can be significant. All of these challenges are heightened with limited tissue sampling.

Small biopsies also force pathologists to be judicious in the workup of such tumors. In many centers, the core biopsy represents the first and perhaps only opportunity for tissue diagnosis. Benign entities may not be excised at all, and sarcomas, particularly of the extremities, are increasingly subject to neoadjuvant therapy, such that they may no longer be recognizable at the time of resection. Since diagnosis may require numerous ancillary tests, including immunohistochemical and molecular studies, it is necessary to develop a thoughtful approach, rooted in histomorphology and clinical information, to make the most of the tissue available.

In our ASCP 2018 Annual Meeting session, Doing More with Less: Developing an Approach to Needle Core Biopsies of Soft Tissue Lesions, on Oct. 3, Jack Brooks, MD, MASCP, and I will take a case-based approach to these challenging tumors, emphasizing our thought process as we encounter individual cases. We discuss the importance of clinical information gathering, as well as the appropriate application and interpretation of tests remains rooted in the morphologic differential diagnosis.

We are excited to reprise this session after receiving positive feedback last year. On a personal level, it is a pleasure to be able to join my mentor, Jack Brooks, to discuss these cases. It brings back fond memories of sitting across the scope from him during fellowship. I often find myself drawing on his morphologic descriptions and terminology as I explain my thought process to our residents and fellows. I think all attendees will gain from his wealth of experience and subtle observations, and may just find themselves borrowing certain turns of phrase in their own discussions with colleagues.

To learn about the ASCP 2018 Annual Meeting’s more than 250 hours of cutting edge education, click here.

John B. Wojcik, MD, PhD, FASCP, is an Assistant Professor in the Department of Pathology and Laboratory Medicine at the University of Pennsylvania Perelman School of Medicine. John S. J. Brooks, MD, MASCP, is a Professor of Pathology and Laboratory Medicine at the University of Pennsylvania Perelman School of Medicine, and is chair of the Department of Pathology, Pennsylvania Hospital. They will co-present the session, Doing More with Less: Developing an Approach to Needle Core Biopsies of Soft Tissue Lesions, on Oct. 3, at 2:40 p.m. during the ASCP 2018 Annual Meeting.