IgG4:IgG ratio >50% Plasma cell rich inflammation and storiform fibrosis and focal obliterative phlebitis, consistent with IgG4 related disease. I added IgG4 to a recent blood sample which was >12 g/L (N range =0.01–1.3 g/L) also strongly supportive of IgG4 disease.

Biopsy of hard painless submandibular gland from a 60ish yr old man. What are the immunostains and what’s the likely diagnosis?#ENTpath #PathTwitter @HeadandNeckPath

A >50 year old photo of me and my dad about to board the boat back from Australia to England!

This is myoepithelial carcinoma arising in a long standing recurrent submandibular pleomorphic salivary adenoma with a CHCHD7::PLAG1 fusion. This gene fusion has no therapeutic target but confirms it’s a genuine ca-ex-PA, rather than de novo myoepithelial ca #Pathtwitter #ENTpath

Gastric glomus tumour with positive DOG1 and synaptophysin expression: a diagnostic challenge https://t.co/LBursRctPz #Pathtwitter @Pathoutlines @diagnexia

The 2026 Diagnexia Histopathology Symposium is open for registration! We are at the Queens College next year, so a new venue. https://t.co/peyxMB7LsB

New UK guidelines on biopsies during upper GI endoscopy 🎯🆕 @FrontGastro_BMJ 📸: https://t.co/1FxVUD1KPH

https://t.co/wafWXEERxI

gastric biopsy from an old man what do you think is going on here? #GIpath #PathTwitter

Clear cell BCC; a rare histologic variant caused by phagolysosomal vacuoles or excess glycogen accumulation. No prognostic implications; it behaves like ordinary BCC. Key is not mistaking it for clear cell SCC, sebaceous neoplasms, or metastatic RCC. #Pathtwitter #dermpath

PS. The last one of these I saw was in a gastric wedge resection in 2006! (Clinicians were convinced it was a GIST of course!)

Incidental polyp in the terminal ileum of a colon cancer right hemicolectomy. IHC negative apart from patchy CD34. This is a benign calcifying fibrous tumour. Can be found anywhere in the GI tract and do not have any syndromic associations (IgG4 IHC was less than 40%) #GIpath

Agree I always do HpIHC on these to avoid missing an easily treatable cause of an otherwise potentially nasty premalignant condition.

Common neighbours but infrequent bed partners...Hyperplastic polyp and tubular adenoma colliding in the same biopsy #GIPath #PathTwitter

Colonic Spirochaetosis. Man with diarrhoea and raised calprotectin but normal endoscopy. Note the fuzzy "pseudo-brush border" highlighted on PAS to the right of the arrow; caused by Brachyspira spirochaetes. Often commensal but may benefit from abx if symptomatic #GIpath

Surgeons and physicians. If you want to increase the time your patients wait for their histology reports, don't include a question or clinical details on the form. This means #pathologists will have to guess what the question is and may do lots of extra irrelevant investigations.

2/2. Lymphoglandular complex-like colorectal carcinoma arising from MLH1-deficient SSL ie intramucosal “dome carcinoma” confined to GALT #pathtwitter #GIpath

1/2. Sessile serrated lesion (SSL) with benign colonisation of lymphoglandular complexes (gut-associated lymphoid tissue / GALT) #pathtwitter @Pathoutlines @RaulSGonzalezMD

The incredible similarity between chlorophyll and haemoglobin - the difference being the magnesium vs iron core 🤯

Tactile corpuscle-like bodies at GOJ in Barrett’s surveillance biopsies. Rare and interesting probable reparative Schwann cell nodules also seen rarely in colon. No clinical significance but can be incidental when targeting a nodule / polyp #GIPath #Pathologists @RaulSGonzalezMD