Consultant Pathologist, Dr KMH
Chennai
Joined August 2016
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Kala Suresh retweeted
Prostate - Radiation or hormonal therapy can induce poorly formed glands.
Do not diagnose poorly formed glands or single-cell pattern 5 after therapy.
Cribriform glands and intraductal carcinoma can still be diagnosed, those are not treatment-induced.
Dr. McKenney. Prostatic Adenocarcinoma Grading: 2026 Update #USCAP #pathology #PathX
Kala Suresh retweeted
Endometrial biopsy, 66 yo
What's your diagnosis and ddx? I need your opinion🌸
#PathTwitter #GynPath
@GynPath @nucleololailo @LangerPath @DrSultanClskn @OlgerHatice @AnneMillsMD @TeamCaptainJohn @UMichPath @CaDxPath @KayParkMD
Kala Suresh retweeted
Gleason 5 - Comedonecrosis
Historically, Gleason called these foci comedonecrosis (pattern 5). Most are actually intraductal carcinoma
Outcome data: IDC-P and invasive carcinoma with comedonecrosis have similar prognosis
Practical point: no need to order basal cell stains just to make that distinction
Dr. McKenney Prostatic Adenocarcinoma Grading: 2026 Update #USCAP #pathology #PathX
Kala Suresh retweeted
65m frontal lobe mass. What’s your diagnosis (see poll below)
#Neuropath #Neuropathology
#CNSpathology #Pathtwitter #Pathx
Kala Suresh retweeted
CLASSIC and gorgeous cytomorphology - a jumbled capillary network weaving through deceptively bland neuroendocrine cells from an intrathyroidal parathyroid neoplasm (adenoma) - "the vascularity and naked nuclei are the clues". (Thyroid, FNA)
Kala Suresh retweeted
WHAT'S NEW IN COLORECTAL TUMORS (WHO 6TH EDITION 2026)
Colon - intramucosal adenocarcinoma
Infiltration is restricted to lamina propria
Most useful feature to identify it: Anastomosing glandular profile. Glands that resemble Gleason pattern 4 (fused glands with no intervening lamina propria) are also helpful
Pic 1: Upper part - intramucosal adenocarcinoma. Lower part - invasion into the submucosa
Pic 3: Intramucosal adenocarcinoma (in red circle). The glands resemble Gleason pattern 4
Dr. Srivastava GIPS pathcast youtube.com/live/mdt3Pr4G1Es… #pathology #PathX
Kala Suresh retweeted
“Can Technology Make Pathologists More Human?”
Joined by a few great people to discuss this topic on @pathologistmag
#pathX #pathtwitter
LINK: thepathologist.com/issues/20… – at New York, NY
Kala Suresh retweeted
🟪Uterine myxoid leiomyosarcoma🟪
Macroscopic:
➡️WHO: myxoid tumours may be gelatinous and friable
➡️May look deceptively circumscribed. Still sample the interface
Diagnostic criteria 🔬
WHO Female Genital 5e, essential criteria box, myxoid:
One or more of:
➡️Moderate to severe cytological atypia (2+/3+)
➡️Tumour cell necrosis
➡️> 0.4 mitoses/mm² (equating to > 1 mitosis/10 HPF of 0.55 mm diameter and 0.24 mm² area)
➡️Infiltrative borders / irregular margins
For contrast, conventional spindle LMS (same box): two or more of marked atypia (2+/3+), tumour cell necrosis, or ≥ 4 mitoses/mm² (equating to ≥ 10 mitoses/10 HPF of 0.55 mm diameter). That mitotic number does not apply here.
Myxoid leiomyoma (WHO leiomyoma box):
➡️Circumscribed, hypocellular and myxoid, lacking cytological atypia or mitoses
STUMP (WHO): exceeds the leiomyoma box, below the LMS box.
Tips:
☑️Extensive sampling may be required to find the diagnostic areas (WHO)
☑️Confirm myxoid stroma (Alcian blue–positive acid mucin), not hydropic oedema (WHO leiomyoma chapter)
☑️Desmin, h-caldesmon, and SMA may be weak or patchy in myxoid tumours (WHO)
☑️CD10 is often positive (WHO). It does not separate this from a stromal tumour
☑️If it sits between the two boxes, that is STUMP. WHO: try to land leiomyoma or LMS first, with generous sampling
#PathTwitter
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Kala Suresh retweeted
Parasitic thyroid nodules = non-neoplastic thyroid tissue that has separated from the main gland
Seen in marked chronic lymphocytic thyroiditis (CLT) or nodular hyperplasia
In CLT they can closely mimic metastatic PTC:
• Dense lymphoid infiltrate + germinal centers → looks like a lymph node
• Reactive follicular atypia → mimics PTC nuclear features
True lymph nodes have a fibrous capsule + subcapsular sinus. The main thyroid will also show CLT
Pitfall ⚠️They are usually sent as "lymph nodes" on frozen sections
Dr. Scognamiglio #USCAP #pathology #PathX #pathtwitter
Kala Suresh retweeted
Pathologic complete response (pCR) per Breast Tumor Molecular Subtype after neoadjuvant chemotherapy
- Higher for TNBC and HER2+ tumors
- Lower for ER + tumors and ILC
Dr. Siziopikou #USCAP #Pathology #PathX #PathTwitter
Kala Suresh retweeted
Updates from the WHO Classification of Breast Tumors, 6th Edition (not published yet)
Mucin producing tumours of high nuclear grade, ER negativity and HER2 positivity are not classified as mucinous carcinoma, but as invasive breast cancer with mucin production.
Dr. Tan #USCAP #pathology #BreastPath #PathX
Kala Suresh retweeted
It's a lovely example of an eccrine spiradenoma. Plentiful lymphocytes are characteristic.
Kala Suresh retweeted
Can you predict FGFR3 mutations in #BladderCancer based on morphology? I am pleased to share this article by Dr. Katrina Collins @katcollmd , which will appear in the August 2026 issue of Laboratory Investigation @LIjournal @virchow
In this study, we found FGFR3 alterations in 17% of urothelial carcinomas, with S249C and Y373C accounting for most mutations. Remarkably, 76% of FGFR3-altered tumors exhibited variant histology, most commonly micropapillary (39%) and squamous differentiation (21%). Both morphologic patterns were exclusively associated with the canonical S249C or Y373C hotspot mutations. Although morphology cannot replace molecular testing, recognizing these histologic patterns may help identify patients most likely to benefit from FGFR3 testing and targeted therapy, particularly in advanced urothelial carcinoma.
Free to download:
authors.elsevier.com/sd/arti…
Kala Suresh retweeted
GI Path 🤝 Breast Path
Invasive lobular carcinoma involving the gallbladder
It looks like inflammation on low power
Colleague case #BreastPath #GIPath #PathX #PathTwitter
Kala Suresh retweeted
#PediPath 6 YO boy with peritoneal and omental tumor, pulm. mets. AFP 27K. Vomiting and abdominal pain. DX?? – at Pittsburgh, PA
Kala Suresh retweeted
Selected for the TCS Sydney Marathon,invested₹2.5L in travel&prep,yet my tourist visa was refused.With deep family&business ties in India,I seek justice from the Australian High Commission for reassessment so I can participate. @SydneyMarathon2026 @AustralianGovt @StockJunkie13