Wednesday, May 28, 2008

He posts, but doesn't understand

I won't pretend that I have any idea of what this recent abstract from the International Journal of Surgical Pathology that I harvested from PubMed means, but I am interested to see more variation in the way the disease looks to pathologists than I previously thought existed.

To digress slightly, I myself am an example of unusual ES pathology: My official diagnosis is that I have the more aggressive proximal subtype of epithelioid sarcoma, but the review pathologist looked at the tissue and pronounced that it was of the distal subtype. All eventually concurred that the sample that went to Harvard for review was anomalous and the diagnosis remained proximal, but clearly there were at least some distal tumor cells in my tumor, perhaps explaining why the course of my disease has been a little slower than it could have been, given its problematic location and metastasis.

The takeaway here is to get your pathology reviewed by a good sarcoma pathologist -- Sharon Weiss at Emory (thank you commenter), Christopher Fletcher at Dana Farber, the armed services institute, someone at a big referral center, etc. And if you've got views on what significance (if any) this abstract has, feel free to enlighten me in the comments.

Anyway, the abstract ("myxoid," by the way, refers to a semi-transparent, glutinous, mucous-like material):

Myxoid Epithelioid Sarcoma: Clinicopathologic Analysis of 2 Cases.

In the nearly 4 decades since its original delineation as a distinct clinicopathologic entity, several morphologic variations of epithelioid sarcoma have been described. Proximal, angiomatoid, and fibroma-like variants have been reported, as have cases displaying significant hyalinization, calcification, and/or ossification. Furthermore, it has long been recognized that epithelioid sarcoma may display focal myxoid change. Herein, the authors describe 2 examples of epithelioid sarcoma that displayed diffuse myxoid change. Both cases were otherwise typical, both morphologically and immunophenotypically, of epithelioid sarcoma. The tumors in both cases were localized, and the patients were treated with wide local excision followed by adjuvant radiotherapy. The patients are free of disease recurrence after 25 and 37 months of follow-up. Differential considerations that may arise because of the composite of morphologic and immunophenotypic findings noted in these cases are discussed, especially if encountered in a small biopsy. These cases further expand the morphologic spectrum of epithelioid sarcoma.

1 comment:

Elizabeth Munroz said...

The pathologist at Emory who specializes in sarcoma diagnosis is named Sharon Weiss.