Welcome to the latest edition of Pulmonary Pathology Reviews, a multi-institutional journal club focused on keeping all participants up-to-date when it comes to the latest peer reviewed publications in print likely to be of interest to those who practice diagnostic pulmonary pathology. This month's journal club comes to us courtesy of Professor Kelly Butnor at the University of Vermont in spectacularly beautiful Burlington! What follows is her OVERVIEW highlighting the good, the bad and the ugly followed by an ARTICLE INDEX with links to PubMed abstracts and full text versions of the articles if your institution is appropriately licensed. Click here to download a PDF version of her article summaries, thumbnails with everything you want to know - and none of the stuff you don't - for this month's crop of articles that were published in June 2016 editions of the relevant journals. Click here if you want to download an MP3 audiofile of the teleconference as it went down on Monday, July 25th, at 9:15 AM EDT.
Culled from the medical literature published in June 2016 is a veritable potpourri of 19 articles, reports, reviews and letters that in some way touch on diagnostic pulmonary pathology, 4 of which have made the subjective cut to be on the docket for discussion.
Warth et al. get granular in terms of lung adenocarcinomas with papillary growth, asking the questions are all papillae created equal and if not, how so? It turns out that papillae with severe architectural distortion and cytologic atypia are associated with a higher stage, poorer survival, and a lower likelihood of being EGFR-mutated than papillae with more uniform cytology and minimal architectural disturbance.
There is a new immunostain on the block for confirming lung as the site of origin of carcinoid tumors. Nonaka et al. report that orthopedia homeobox (OTP) immunoexpression is largely restricted to pulmonary carcinoids and hyperplastic neuroendocrine lesions, such as DIPNECH.
Oldham et al. attempt to systematically validate criteria of interstitial pneumonia with autoimmune features (IPAF) and show that IPAF patients with UIP have survival similar to IPF patients.
Wilshire et al. report on a better way to separate out adenocarcinomas with a low risk of recurrence following complete resection than the current AJCC Classification by using an integrated system that combines AJCC staging with the IASLC/ATS/ERS classification of lepidic adenocarcinoma.
A study by Arossi et al. highlights the association of nodular pulmonary light chain deposition disease with MALT lymphoma and autoimmune disease, while Hasegawa et al. describe a prediction model for EGFR mutations based on CT findings.
Mourah et al. show BRAF mutation testing is not enough in pulmonary Langerhans cell histiocytosis because some cases may harbor NRAS mutations, which might benefit from MEK inhibitor therapy rather than BRAF inhibitors.
Rossi et al. offer a thorough update on DIPNECH and propose the term DIPNECH syndrome to identify a subset of patients with airways disease who may have an increased likelihood of poor outcome.
No contemporary pulmonary pathology journal club would be complete without an article or two on PD-L1. This month, Cedres et al. and Combaz-Lair et al. examine PD-L1 in malignant mesothelioma, finding that while this pathway is frequently activated, much remains to be understood about what role immune blockade therapies have in this intractable disease. Rounding out the month is a letter to the editor by Montironi et al., which puts the worldwide economic impact of treating patients with metastatic NSCLC with anit-PD-L1 agents into perspective.
Happy reading and happy summer!
ARTICLE INDEX (with PubMed links)
Articles for Discussion
Warth et al. Clinical relevance of different papillary growth patterns of pulmonary adenocarcinoma. Am J Surg Pathol. 2016 Jun;40(6):818-26
Nonaka et al. Diagnostic utility of orthopedia homeobox (OTP) in pulmonary carcinoid tumors. Am J Surg Pathol. 2016 Jun;40(6):738-44
Oldham et al. Characterisation of patients with interstitial pneumonia with autoimmune features. Eur Respir J. 2016 Jun;47(6):1767-75
Wilshire et al. Comparison of outcomes for patients with lepidic pulmonary adenocarcinoma defined by 2 staging systems: A North American experience. J Thorac Cardiovasc Surg. 2016 Jun;151(6):1561-8
Articles for Notation
Arrossi et al. Nodular pulmonary light chain deposition disease: an entity associated with Sjögren syndrome or marginal zone lymphoma. J Clin Pathol. 2016 Jun;69(6):490-6
Cedres et al. Analysis of expression of PTEN/PI3K pathway and programmed cell death ligand 1 (PD-L1) in malignant pleural mesothelioma (MPM). Lung Cancer. 2016 Jun;96:1-6.
Combaz-Lair et al. Immune biomarkers PD-1/PD-L1 and TLR3 in malignant pleural mesotheliomas. Hum Pathol. 2016 Jun;52:9-18
Faruki et al. Validation of the lung subtyping panel in multiple fresh-frozen and formalin-fixed, paraffin-embedded lung tumor gene expression data sets. Arch Pathol Lab Med. 2016 Jun;140(6):536-42
Hasegawa et al. CT features of epidermal growth factor receptor-mutated adenocarcinoma of the lung: comparison with nonmutated adenocarcinoma. J Thorac Oncol. 2016 Jun;11(6):819-2.
Micke et al. The impact of the fourth edition of the WHO classification of lung tumours on histological classification of resected pulmonary NSCCs. J Thorac Oncol. 2016 Jun;11(6):862-72
Mourah et al. Recurrent NRAS mutations in pulmonary Langerhans cell histiocytosis. Eur Respir J. 2016 Jun;47(6):1785-96
Oliveira et al. The relationship between lung cancer histology and the clinicopathological characteristics of bone metastases. Lung Cancer. 2016 Jun;96:19-24
Pelosi et al. Deciphering intra-tumor heterogeneity of lung adenocarcinoma confirms that dominant, branching, and private gene mutations occur within individual tumor nodules. Virchows Arch. 2016 Jun;468(6):651-62
Bremnes et al. The role of tumor-infiltrating lymphocytes in development, progression, and prognosis of non small cell lung cancer. J Thorac Oncol. 2016 Jun;11(6):789-800
Rossi et al. Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia syndrome. Eur Respir J. 2016 Jun;47(6):1829-41
Montesi et al. Case records of the Massachusetts General Hospital. Case 17-2016. A 60-year-old woman with increasing dyspnea. N Engl J Med. 2016 Jun 9;374(23):2269-79
Letters to the Editor
de Kock et al. Somatic DICER1 mutations in adult-onset pulmonary blastoma. Eur Respir J. 2016 Jun;47(6):1879-82.
Montironi et al. Testing PD-1/PD-L1 expression in cancer therapy: pathologic Insights and economic sustainability. Arch Pathol Lab Med. 2016 Jun;140(6):501-2