There are few tumours with SMARCA4 loss (in a male) and fewer with SALL4 expression/negative panCK staining. So I was reasonably confident that this was a metastatic thoracic SMARCA4-deficient undifferentiated tumour, and pleased when sequencing confirmed loss along with p53 mutation.

And this is the SMARCA4, showing loss in the tumour with retained expression in adjacent tissue.

Next panel… the last ditch attempt for CUP including POU2F3, NUT, INI-1, and SMARCA4.

Initial panel for of IHC showed weak staining for TTF-1, focal Cam5.2. CD45, other cytokeratins, most melanocytic markers, neuroendocrine markers, mesothelial markers, glial markers all negative.

SALL-4 was positive 🤔

So far, so metastatic. Sheets of cells, doesn’t have the discohesion I’d expect for melanoma or lymphoma but high grade and poorly differentiated so anything possible.

A conundrum of a case from last year. Large brain lesion. No known hx of malignancy. No definite lesions on imaging elsewhere. Minimal hx provided in general. Frozen and paraffin sections: malignancy sharply demarcated from normal glial tissue. Does not look like a primary brain lesion. #PathSky

BerEP4 ➡️ Clear cell variant of BCC.

Positive for p40. Doesn’t look squamoid and no overlying dysplasia… negative for SOX10, MelanA, AR, CEA, EMA, PAX-8.

High power view. Some mucin in the nests. Small, hyperchromatic nuclei, clear cytoplasm.

One of many skin lesions removed. Standard level of Australian solar elastosis.
Invasive nests, vague peripheral palisading. #PathSky

Lovely example of a pulmonary hamartoma and I’m sure removal from the bronchus has been therapeutic 😳

Mostly cartilage, with a central fatty core, some invaginated respiratory epithelium.

Endobronchial lesion, reasonably chunky, somehow an “incidental” finding. #PathSky

Four leaf unlucky mitosis 🍀 #PathSky

Metastasis in motion. Tumour tracking towards the already pretty chockers lymph node.

The WHO #BlueBooks 6th ed. is coming out! Updates are based on current research and evidence - based. Each volume has an editor from a resource challenged setting. Increased harmonisation across volumes is pursued. Most entities include WSI’s . #GI6th & #Breast6th #Pathology

In Australia it’s Junior Doctor New Year. Traditional gifts given for this holiday include pens, coffee vouchers, and mandatory training modules.

A straight ratcheted forcep, labelled 'Needle Gripper- Quilting' displayed amongst sewing machines and other quilting supplies.

The quilting section at Spotlight makes the 'are women suited to surgery?' discussion seem ludicrous. Quilters have been piecing fabric and driving needles through complex designs for centuries. Needle holders, right angle forceps, cutting blades- all here. #ILookLikeASurgeon #MedSky

Why on earth would I want to know about uterine cervicitis or cervicitis with that search phrase? Is this the new dumbing down of PubMed?

It’s the looks from the sheep that get me!

Even less cute

Not cute

Cute

Putting the macro in macrophage

The only cute thing about this case on my desk. #PathSky

Surely the only thing a powerful magnet could cure is the awful condition, which besets many in healthcare, of being a 💩 magnet. (As long as the polarity is reversed.)

Great culture can save lives. Literally.

Amazing letter in today’s @thetimes.com about Tom Stoppard

I don’t know if anyone else notices or cares, but when I see a presentation in which the speaker uses obviously generated-AI images to illustrate their slides, it makes me immediately less confident in whatever other content they’re presenting.