The edition · Pathology
Any non-glandular tumour focus at the front was linked to nodes in pT1 colorectal cancer
A 2,611-patient study found a single-cell threshold outperformed budding and poorly differentiated clusters. Plus MTAP testing in lung cancer, and identifying haemophilia carriers.
The edition in brief
A six-centre Chinese study of 2,611 resected pT1 colorectal cancers defined peritumoral malignant cellular foci as any non-glandular focus of one or more tumour cells at the invasive front. Unlike tumour budding and poorly differentiated clusters, which were inconsistent across cohorts, this feature was independently associated with lymph node metastasis in both training and validation sets, and more strongly with apical (D3) nodes. It needs external validation before it changes reporting standards, but it is worth recording. In 5,233 sequenced lung cancers, homozygous MTAP deletion occurred in 5.6%, more often in never or light smokers and with EGFR or ALK drivers; NGS and immunohistochemistry agreed in 97.3% of 105 tested cases once samples with 30% tumour or less were excluded, with IHC more sensitive in low-cellularity or subclonal disease. In 90 intrahepatic cholangiocarcinomas, FGFR2/3-altered tumours were younger, small-duct, non-mucinous and TP53-poor, with better univariable disease-specific survival that did not survive adjustment. A Blood review sets out a family-based approach to finding haemophilia carriers and women with haemophilia. The pearl covers fixation times that protect biomarker results.
Haemophilia carriers and women with haemophilia are still missed
Test factor activity, not just the APTT, in female relatives of men with haemophilia, and confirm genetically where possible.
MTAP loss in lung cancer: IHC and NGS largely agree
Use MTAP IHC as a sensitive complement to NGS, particularly on low-cellularity lung biopsies.
FGFR2/3-altered intrahepatic cholangiocarcinoma has a recognisable profile
Flag small-duct, non-mucinous intrahepatic cholangiocarcinoma for fusion-capable FGFR2 testing.
Fixation times that protect biomarker results
Record cold ischaemic and fixation times on every specimen sent for biomarker testing.
Peritumoral malignant cellular foci and nodal risk in pT1 colorectal cancer
Consider noting non-glandular tumour foci at the invasive front in pT1 colorectal reports while continuing standard high-risk reporting.
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