Human Pathology

June 2009

Lau SK, Weiss LM. The Weiss system for evaluating adrenocortical neoplasms: 25 years later. Hum Pathol 2009;40:757–68.

The Weiss system is the standard protocol for the assessment and categorisation of adrenal cortical tumours, 20 plus years after the seminal publication. This review revisits the original criteria: high nuclear grade, >5/50 HPF mitoses, atypical mitoses, <25% clear cells, >1/3 diffuse architecture, necrosis and invasion (capsular, venous, sinusoidal), with three or more of these features corresponding to malignant behaviour. The modified Weiss criteria published in 2002 permitted greater reproducibility: mitoses >5/50 HPF, clear cells <25%, abnormal mitoses, necrosis, capsular invasion. Note that both paediatric tumours (>400 g, >10 cm, >15/20 mitoses) and oncocytic tumour (>10 cm, >200 g) require a slightly modified approach.

van Deurzen CH, de Bruin PC, Koelemij R, et al. Isolated tumor cells in breast cancer sentinel lymph nodes: displacement or metastases? An immunohistochemical study. Hum Pathol 2009;40:778–82.

The origin, significance and progression of isolated tumour cells in breast cancer sentinel lymph nodes are uncertain. True lymph node metastases are often associated with aberrant protein expression by immunohistochemistry. This study explored proteins that are often overexpressed in breast cancer such as cyclin D1 and p53 to ascertain the malignant potential of these isolated tumour cells. Of 383 consecutive patients with primary invasive breast cancer and sentinel lymph node involvement, 40 had isolated tumour cells in the sentinel lymph nodes, of which 16 sentinel lymph nodes contained isolated tumour cells in newly cut sections that were available to study. Immunohistochemistry findings on the primary tumour and the isolated tumour cells in the sentinel lymph nodes were compared. Sentinel lymph node isolated tumour cells as a group showed significantly lower expression of cyclin D1 and p53 than micrometastases and macrometastases (controls). Cyclin D1 expression of the primary tumour and the corresponding …