655 W 8Th Street Department Of Pathology
Jacksonville FL 32209
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Male Breast: Clinical and Imaging Evaluations of Benign and Malignant Entities with Histologic Correlation. - The American journal of medicine
Breast cancer is an uncommon disease in men. As a result, the diagnosis may not initially be considered. Understanding the common benign and malignant entities affecting the male breast is critical for timely and accurate diagnosis in the primary care setting. Most patients present with a palpable breast mass or pain. The usual etiology is gynecomastia, the most common breast condition in males, but breast cancer must always be excluded through careful imaging evaluation when physical examination findings are suspicious or inconclusive. Imaging of the male breast generally relies on mammography and ultrasound with mammography employed as the initial imaging modality of choice and ultrasound when a mass is detected or suspected. Here we describe the normal male breast anatomy and present an evaluation algorithm for the male patient with breast signs or symptoms. The most common benign and malignant entities are described.Copyright Â© 2016 Elsevier Inc. All rights reserved.
Recurrent Systemic Anaplastic Lymphoma Kinase-Negative Anaplastic Large Cell Lymphoma Presenting as a Breast Implant-Associated Lesion. - Cancer control : journal of the Moffitt Cancer Center
A woman aged 48 years presented with fevers, chills, weight loss, and night sweats. She had significant lymphadenopathy of the left neck as well as the left axilla. Her history was significant for bilateral breast augmentation with textured silicone implants more than 25 years ago. Excisional biopsy of a cervical lymph node revealed large, atypical cells positive for CD4 and CD30 and negative for Epstein-Barr virus-encoded ribonucleic acid, CD2, CD3, CD5, CD7, CD8, CD15, CD20, pan-keratin, S100, anaplastic lymphoma kinase (ALK), and paired box 5. These findings were consistent with Ann Arbor stage IIIB ALK-anaplastic large cell lymphoma (ALCL). The patient was started on 6 cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone. She initially had no signs or symptoms of breast involvement; however, after developing seroma during the clinical course, the patient underwent capsulectomy and removal of the intact, textured silicone implants. Pathological evaluation demonstrated ALK-ALCL in the left breast capsule with cells displaying a significant degree of pleomorphism with binucleated forms and numerous mitoses. Fluorescence in situ hybridization confirmed the tumor was negative for t(2;5). She presented 8 weeks later showing evidence of recurrent systemic disease.
Her-2 Expression in Gastroesophageal Intestinal Metaplasia, Dysplasia, and Adenocarcinoma. - Applied immunohistochemistry & molecular morphology : AIMM / official publication of the Society for Applied Immunohistochemistry
Overexpression of human epidermal growth factor receptor 2 protein (Her-2) in Barrett neoplasia is significant for targeted therapy with trastuzumab. Here, we studied the frequency of Her-2 overexpression in Barrett adenocarcinoma and precursor lesions. Retrospective formalin-fixed paraffin-embedded tissue samples of 25 normal (NM) esophageal mucosa, 50 Barrett esophagus (BE) without dysplasia, 49 BE with low-grade dysplasia (LGD), 50 BE with high-grade dysplasia (HGD), and 50 invasive adenocarcinoma (ICA) were used. A BE tissue microarray was built and analyzed by Her-2 immunohistochemistry (IHC) and Her-2 dual in situ hybridization (DISH). Her-2 IHC expression was negative in NM and low in 26% of BE (IHC score: 1+) and in 24.5% of LGD (IHC score: 1 to 2+). Her-2 overexpression was seen in 28% of HGD and in 24% of ICA (IHC score: 2 to 3+). Her-2 DISH was negative in NM and BE but positive in 6% of LGD, 20% of HGD, and 18% of ICA. Differences in Her-2 DISH positivity between NM and HGD or ICA were statistically significant (P=0.02), but those between NM and LGD or HGD and ICA were not (P=0.2). Although Her-2 overexpression results in ICA were similar to previous reports, the finding of 28% in HGD was unexpected and may have clinical implications. Positive Her-2 DISH in 6% of LGD is novel, suggesting a role of Her-2 during BE progression.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/4.0/.
Primary Breast Angiosarcoma in a Male. - The breast journal
Angiosarcoma of the breast represent <1% of breast malignancies. It can arise de novo (primary) or following treatment for breast carcinoma (secondary). Primary breast angiosarcoma usually affects young women and is extremely rare in the male patient population. Imaging features can have a nonspecific appearance. Histologically, the diagnosis can be challenging, especially in small core needle biopsies. Mastectomy or wide local excision is the usual treatment for both forms of angiosarcoma. Prognosis and recurrence is worse with increasing grade of tumor. Herein, we discuss the rare occurrence of primary breast angiosarcoma in a man with history of immunodeficiency. Clinical, radiological and pathologic findings will be discussed.Â© 2015 Wiley Periodicals, Inc.
Use of Immunohistochemical Stains in Epithelial Lesions of the Breast. - Cancer control : journal of the Moffitt Cancer Center
During the last few decades, immunohistochemistry (IHC) has become an integral part of pathology. Although hematoxylin and eosin (H & E) stain remains the fundamental basis for diagnostic pathology of the breast, IHC stains provide useful and sometimes vital information. Moreover, considering the role of hormonal therapy in hormone receptor-positive breast tumors, as well as the availability of targeted chemotherapeutic agents for HER2-positive cases, IHC studies represent a major part of workups.A literature search was performed to explore the uses of IHC stains related to the diagnoses of breast lesions and prognostic/predictive information.Selective use of IHC stains in conjunction with H & E examination helps resolve most diagnostic issues encountered by surgical pathologists during their day-to-day practice. Pathologists should be familiar with the use of each immunostain and its limitations to avoid interpretative errors.IHC stains help guide the differential diagnosis of challenging epithelial lesions of the breast. They should be selectively and judiciously used and their findings must be interpreted with the differential diagnoses in mind and with an understanding of possible pitfalls.
Advances in the Molecular Analysis of Breast Cancer: Pathway Toward Personalized Medicine. - Cancer control : journal of the Moffitt Cancer Center
Breast cancer is a heterogeneous disease that encompasses a wide range of clinical behaviors and histological and molecular variants. It is the most common type of cancer affecting women worldwide and is the second leading cause of cancer death.A comprehensive literature search was performed to explore the advances in molecular medicine related to the diagnosis and treatment of breast cancer.During the last few decades, advances in molecular medicine have changed the landscape of cancer treatment as new molecular tests complement and, in many instances, exceed traditional methods for determining patient prognosis and response to treatment options. Personalized medicine is becoming the standard of care around the world. Developments in molecular profiling, genomic analysis, and the discovery of targeted drug therapies have significantly improved patient survival rates and quality of life.This review highlights what pathologists need to know about current molecular tests for classification and prognostic/ predictive assessment of breast carcinoma as well as their role as part of the medical team.
Overexpression of Vascular Endothelial Growth Factor A in Invasive Micropapillary Colorectal Carcinoma. - Cancer control : journal of the Moffitt Cancer Center
Invasive micropapillary carcinoma (IMPC) is a rare variant of colorectal cancer with an adverse prognosis. "Retraction artifact" around tumor cells is a feature of IMPC. The aim of this study was to assess the nature of the retractions around the tumor cells and to describe the histopathological features of a group of 18 cases of IMPC.A pathology review of 128 consecutive colorectal cancers identified 18 cases of histologically proven IMPC using 5% of the total tumor volume comprised of a micropapillary component as the diagnostic criterion. Immunostains for D2-40, CD31, CD34, vascular endothelial growth factor A (VEGF-A), and mucin 1 (MUC-1) were performed using the avidin-biotin complex method.Cases of IMPC were characterized by pseudomicropapillae surrounded by lacunar-like clear spaces. These structures exhibited the inside-out growth pattern as highlighted by MUC-1 staining. The lining of the lacunar spaces was immunoreactive to CD31 but not CD34 or D2-40, indicating that they are neovascular structures. Furthermore, the tumor cells strongly and diffusely expressed VEGF-A.The strong coexpression of VEGF-A and CD31 suggests a prominent role of neoangiogenesis in these tumors.
Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of Affordable Care Act: a changing landscape. - Diagnostic cytopathology
Proven as a time challenged and cost-effective sampling procedure, the use of FNAB has still remained controversial among the scientific community. Currently, other minimally invasive sampling procedures such as ultrasound guided fine needle aspiration biopsy (US-FNAB) and image guided core needle biopsy (IG-CNB) have become the preferred sampling procedures for evaluation of breast lesions. However, changes in the medical economy and the current growing emphasis on cost containment in the era of the Affordable Care Act make it necessary to stimulate a renewed interest in the use of FNAB as the initial diagnostic sampling procedure. This study was designed to define the changing trend in the practice of tissue sampling during the last several years, and to assess the comparative effectiveness and appropriateness of the procedure of choice for breast cancer diagnosis.After Institutional Review Board (IRB) approval, the computer database of the Pathology Department, University of Florida, College of Medicine-Jacksonville at UF Health was retrospectively searched to identify all breast biopsy pathology reports issued during the period of January 2004 to December 2011. The inclusion criteria were all women that underwent any of the following biopsy types: FNAB, US-FNAB, IG-CNB, and surgical biopsy (SB). Diagnostic procedures were identified using current procedural terminology (CPT) codes recorded on claims from the UF Health Jacksonville patient accounting application files. The data obtained was used to determine which technique has the best cost-effectiveness in the diagnosis of breast cancer. The outcome variable for this project was a positive breast cancer diagnosis resulting from these methodologies. The predictor variable was the biopsy type used for sampling. The rate of cancer detection for each procedure was also determined.Among the four groups of procedures compared, the lower cost was attributed to FNAB, followed by US-FNAB, and SB. IG-CNB was the most costly procedure, even more expensive than SB. The more costs associated with IG-CNB compared to SB is related to the expense involved in the use of localizing devices and also attempts to sample a lesion more than once. More importantly, cancer yield by FNAB was the highest among all the procedures under study.This study confirms the comparative effectiveness of FNAB in the evaluation of patients with breast cancer and justifies serious endorsement of this procedure as the initial diagnostic sampling modality for its unique potential in rapid reporting and cost-saving.Â© 2015 Wiley Periodicals, Inc.
Beta-catenin expression patterns in matched pre- and post-neoadjuvant chemotherapy-resistant breast cancer. - Annals of clinical and laboratory science
Î²-catenin is a critical component of the cadherin cell-to-cell adhesion pathway and a key participant in the Wnt signaling pathway. Activation of Î²-catenin signaling in the Wnt pathway is a known contributor to tumor cancer progression and metastasis and may result in resistance to chemotherapeutic agents. The aim of this study is to evaluate the patterns of expression of Î²-catenin in breast carcinoma cells before and after neoadjuvant chemotherapy. Discovery of the molecular mechanisms responsible for resistance to chemotherapy treatment could result in more effective therapy, and improve outcome and survival.Twenty-nine matched pre-treatment and post-neoadjuvant chemotherapy breast carcinomas were subjected to immunohistochemical study using anti-Î²-catenin antibody. Normal staining was defined as crisp membrane staining in >90% tumor cells; aberrant expression was nuclear staining in >5% tumor cells.Of the 29 included cases, five cases of invasive lobular carcinoma lacked Î²-catenin immunoreactivity pre- and post-treatment. Mildly reduced membranous staining was seen in two post-treatment samples. One case of triple-negative ductal carcinoma had reduced pre- and post-treatment staining. All other cases showed normal pre- and post-treatment Î²-catenin expression. No aberrant staining was identified.In our study, there was no difference in the expression of Î²-catenin in pre- and post-neoadjuvant chemotherapy specimens. These results do not suggest that Î²-catenin plays a role in conferring neoadjuvant chemotherapy resistance.Â© 2015 by the Association of Clinical Scientists, Inc.
Pathologic evaluation of sentinel nodes. - Cancer journal (Sudbury, Mass.)
Optimal utilization of sentinel node biopsy in the care of cancer patients requires cooperation between the radiologist, surgeon, and the pathologist. Accurate pathologic diagnosis of the sentinel node is central to correct staging, optimal treatment decisions, and precise prognostication of patients with melanoma, breast, colorectal, lung, and gastric cancer. Intraoperative handling, gross dissection, and histologic/immunohistochemical evaluation techniques are all key components of this process. Although not currently part of routine handling, newer molecular techniques may potentially add to the valuable information gained from evaluating sentinel node specimens.
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655 W 8Th Street Department Of Pathology Jacksonville, FL 32209
580 W 8Th St Tw 1 8Th Floor
655 W 8Th St Ufjp Pathology Dept.
655 W. Eighth St. Clinical Center, 1St Floor
655 W 8Th St 2Nd Flr Clinical Ctr University Of Florida Jackson
Morris Ctr. 580 West 8Th St.
653-1 W 8Th St Lrc 3Rd Floor
655 W 8Th St # C90 2Nd Floor, Clinical Center