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Background The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer. Methods We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated. Results A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors ( P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen. Conclusion This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen. [ABSTRACT FROM AUTHOR]

Invasion of peripheral nerves by epithelial cells has been traditionally regarded as a feature diagnostic of malignancy, its presence therefore being often sought to document a diagnosis of carcinoma, particularly in the breast. Perineural involvement (PNI) by benign breast disease is not often seen and the etiology is uncertain. The first reported case of nerve invasion in a benign breast lesion was by Ackerman in 1957. Subsequent reports have further confirmed this finding in the breast. The most challenging observation is when the glands involving nerves show cytologic and architectural features of the adjacent atypical duct hyperplasia (ADH) or ductal carcinoma in situ (DCIS). Here, we describe a case of ductal carcinoma in situ grade 2 with nerve involvement in a lumpectomy specimen in a 59-year-old woman. To the best of our knowledge, only five cases of atypical duct hyperplasia by Gobbi et al. and four cases of ductal carcinoma in situ, 3 by Gobi et al. and 1 by Tsang and Chan, associated with nerve involvement, have been reported in English medical literature. Two layers of epithelial cells with the immunohistochemical demonstration of the preservation of a continuous myoepithelial layer in the mammary ducts within the nearby small nerves, is the main clue to confirm the in-situ nature of the inclusions. It is necessary to be aware of this phenomenon in breast lesions to avoid over-diagnosis and inappropriate surgery. [ABSTRACT FROM AUTHOR]

• Genomic studies were reviewed for renal cell carcinoma (RCC), including clear cell RCC, papillary RCC, chromophobe RCC, and the translocation RCC involving TFE3 and TFEB rearrangements, as well as benign oncocytoma, which together comprise about 95% of all renal cell neoplasia. • This evidence-based review provides a validated role for assessment of CNAs in renal cell neoplasia in the clinical setting. • It can assist in renal cell neoplasm diagnosis and sub-classification within subtypes that is integral to the management of patients. Renal cell neoplasia are heterogeneous with diverse histology, genetic alterations, and clinical behavior that are diagnosed mostly on morphologic features. The Renal Cell Neoplasia Workgroup of the Cancer Genomics Consortium systematically evaluated peer-reviewed literature on genomic studies of renal cell carcinoma (RCC), including clear cell RCC, papillary RCC, chromophobe RCC, and the translocation RCC involving TFE3, TFEB and MITF rearrangements, as well as benign oncocytoma, which together comprise about 95% of all renal cell neoplasia. The Workgroup curated recurrent copy number alterations (CNAs), copy-neutral loss-of-heterozygosity (cnLOH), rearrangements, and mutations, found in each subtype and assigned clinical relevance according to established criteria. In clear cell RCC, loss of 3p has a disease-initiating role and most likely also in progression with mutations detected in VHL and other genes mapped to this arm, and loss of 9p and/or 14q has well-substantiated prognostic utility. Gain of chromosomes 7 and 17 are hallmark CNAs of papillary RCC, but patterns of other CNAs as detected by chromosomal microarray analysis (CMA) afford sub-classification into Type 1 and 2 with prognostic value, and for further sub-stratification of Type 2. Inherent chromosome loss in chromophobe RCC as detected by CMA is useful for distinguishing the eosinophilic variant from benign oncocytoma which in contrast exhibits few CNAs or rearranged CCND1 , but share mitochondrial DNA mutations. In morphologically atypical RCCs, rearrangement of TFE3 and TFEB should be considered in the differential diagnosis, portending an aggressive RCC subtype. Overall, this evidence-based review provides a validated role for assessment of CNAs in renal cell neoplasia in the clinical setting to assist in renal cell neoplasm diagnosis and sub-classification within subtypes that is integral to the management of patients, from small incidentally found renal masses to larger surgically resected specimens, and simultaneously identify the presence of key alterations portending outcome in malignant RCC subtypes. [ABSTRACT FROM AUTHOR]

• Diverse frameworks exist for categorizing genomic abnormalities. • Genomic profiling in the clinical setting is currently mostly RNA based. • DNA based genomic profiling is increasingly used for advanced / metastatic disease Genomic abnormalities in breast cancer have been described according to diverse conceptual frameworks, including histologic subtypes, clinical molecular subtypes, intrinsic DNA, RNA, and epigenetic profiles, and activated molecular pathways. The Cancer Genomics Consortium (CGC) Breast Cancer Workgroup performed an evidence based literature review to summarize current knowledge of clinically significant genomic alterations in breast cancer using CGC levels of evidence. Targetable or disease-defining alterations were prioritized. We summarized genomic alterations in breast cancer within a framework of existing clinical tools for diagnosis, risk stratification, and therapeutic management. Using CGC levels of evidence, we catalog copy number profiles, gene expression profiles, and mutations in clinically significant genes. We also describe emerging molecular markers such as methylation profiling and immunotherapy biomarkers. A summary of currently available information on breast cancer genomics will enhance precision medicine by serving as an interpretive resource for clinical laboratory geneticists, providing a foundation for future practice guidelines, and identifying knowledge gaps to address in future research. [ABSTRACT FROM AUTHOR]

Purpose: To test the hypothesis that a modified approach to portal vein embolization (PVE)-termed ablative liver partition (ALP) and PVE (ALP-PVE)-is feasible and results in greater future liver remnant (FLR) growth compared with PVE alone in a rabbit model.Materials and Methods: Eighteen rabbits (median weight, 2.7 kg) underwent PVE (n = 9) or ALP-PVE (n = 9). PVE to cranial liver lobes was performed with 100-300-μm microspheres and metallic coils; the caudal lobe was spared as the FLR. In the ALP-PVE cohort, a liver partition between cranial and caudal lobes was created by using microwave ablation (40 W, 1 min). Animals were euthanized and livers were harvested on postprocedure day 7. Caudal and cranial liver lobes were weighed after 4 weeks of oven drying. Ki-67 immunohistochemistry was used to quantify liver mitotic index. ALP-PVE feasibility was determined based on procedure technical success. Standardized FLR (sFLR; ie, FLR divided by whole liver weight) and mitotic index were compared between PVE and ALP-PVE groups by two-tailed independent-samples Mann-Whitney U test.Results: One PVE-group rabbit died during anesthesia induction and was excluded from technical success calculation. Eight of 8 (100%) and 8 of 9 rabbits (89%) underwent technically successful PVE and ALP-PVE, respectively. There was no difference in sex or weight distribution between groups. sFLR (0.32 vs 0.29; P = .022) and mitotic index (17.5% vs 6.2%; P = .051) were higher in ALP-PVE vs PVE caudal lobes when the first "learning-curve" case from each group was excluded.Conclusions: ALP-PVE is feasible and may stimulate greater FLR growth compared with PVE in a rabbit model. [ABSTRACT FROM AUTHOR]