Andrew Bellizzi 🇺🇦
@IHC_guy
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#SlavaUkraini ; Immunohistochemistry; GI/NET/CUP/BST path; hiking; cooking; @RedSox ; @NDFootball ; @ISIMMWeb ; @AIMMJournal ; Gunslinger for Hire; #DadJokes ; Dad
Iowa City, IA
Joined April 2020
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On this special day, I can’t resist sharing this lovely note from my mentor and friend, Frank.
We share a deep and abiding love for baseball, language, and GI Pathology❤️
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In this installment of "Andrew gets overly excited about normal histology" . . . can any
#PathCurious
med students and/or R1s tell me who's in the box and who's in the circle. And how does the structure of these cells serve their function???
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I'm excited to share my latest work of synthesis.
This review presents:
1. Diagnostic pathology-relevant TP53 biology
2. Pattern-based approach to p53 IHC interp
3. Optimization/validation/controls/EQA
4. Pan-cancer diagnostic applications
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It always amazes me the extent to which these tissues are self-aware.
#TheScream
#EdvardMunch
#AtypicalMitoticFigure
#HSIL
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My dad just died ... lung cancer ... 2.5 months from his initial diagnosis ... I’m going to be discombobulated for a little while ... thanks for understanding ...
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@Chucktowndoc
@JLHornick
How often do I order a KIT in giardiasis??? . . . only EVERY time!!!
#EverydayAndTwiceOnSunday
#DontFireUntilYouSeeTheBrownsOfTheirEyes
My favorite ref: C-kit (CD117) immunostain is useful for the diagnosis of Giardia lamblia in duodenal biopsies
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I'm a little bashful to do self-promotion😊😊😊, but I'm writing to invite everyone to my
#Zoom
webinar this Wednesday morning at 11 AM Eastern: High-Grade Neoplasms of Uncertain Lineage: Do's and Don'ts of "Ancillary" Testing.
Register in advance here:
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Congratulations to all of those celebrating the dispositions of their
@TheUSCAP
abstracts!!!
I wanted to take a second to post this, though. It isn't all unicorns and rainbows, and that's OK. You win some. You lose . . . many. Hold your head high. It's how you play that matters.
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As promised, here are the protocols for the 10 Emerging Next-Gen IHC Markers discussed this past Wednesday.
Looking forward to seeing everyone again this Fall for the next series.
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Does this histologic image remind anyone else of this emoji 🤯🤯🤯 OR am I losing touch with reality OR perhaps both . . .
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Something nice happened unexpectedly today. My resident & I had a GIST on Friday & I asked him to fill out a synoptic. Today he said, “I noticed something interesting about the authorship.”
We often toil in relative obscurity & it’s nice when someone takes a moment to notice …
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Hot off my keyboard and soon be on
#PathTwitter
🔥🔥🔥
Another overly long
@IHC_guy
instant classic … loaded with
#wallhangers
.
Headed to
@HardinLib
for my “read aloud for typos” ritual before submitting to THE IHC journal.
And, yes, this damn near killed me😂
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Too perfect not to share . . .
Keratin AE1/AE3 in a well-differentiated pancreatic neuroendocrine tumor.
#dotlikewhatsnottolike
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I guarantee that I'm the only one on
#PathTwitter
signing out EM right now.
Look at that brush border and those cell junctions . . . hubba hubba😊😊😊
#FormFollowsFunction
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Anybody care to help me with this case I duffed??? My pal Frank likes to wax that "the eye does not see what the mind does not know." I like to talk about "diagnostic fluency" ... if you're not well-practiced, it's hard to notice stuff, even if you "know" what to look for.
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E-cadherin is completely lost in vast majority of lobular neoplasia of all types BUT up to 15% have "aberrant" staining, which may be misinterpreted as intact/normal. p120 & beta-catenin may be useful in challenging cases.
In general, H&E is Queen; if dx is clear-->don't stain.
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For CUP enthusiasts (I’m looking at you
@OncoThor
😊), my chapter expands upon the approach I presented in my previous expansive review on this topic ().
It’s written in “bullet point” format, for ease of daily use:
#wallhangers
NEWEST Molecular Pathology book (736 pages, 25 chapters) just released this week! We are immensely grateful for the contributions by our internationally renowned authors who have shared their knowledge and expertise in this exciting field.
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It took a pandemic to get me on this thing, and now . . . oh boy!!!
Looking forward to using this as a platform to share my joy of pathology, to teach, and to learn.
Expect lots of tricky cases with even more brown stains😎
Hope all my friends are staying well.
#whatsahashtag
Check out the
#capvirtualpath
lecture tomorrow at 10 AM CDT, presented by
@UIPathology
faculty Dr. Andrew Bellizzi, to learn about his approach to undifferentiated immunohistochemistry! Sign up at
@KMirza
@CarnoldG
@ALBoothMD
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Can a pattern just be a pattern?
I was reviewing duodenal NETs for a project with
@CatherineGTran
today when I came across this beauty.
I see NETs with some rhabdoid cytomorphology 2-3x a yr.
Given what I've learned the last few yrs, I've ordered a SMARCA4 & a SMARCB1 . . .
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FNA of a gallbladder mass. Diagnosis?
This one has
#PathTwitter
written all over it.
@HubertLauMD
is going to make the diagnosis in the blink of an eye . . . this one took me a couple beats.
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I am reminded over and over again that the best immunostain is . . . H&E😂😂😂
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Case of the Day? 30ish-year-old woman on oral contraceptives with 2 cm liver tumor. For the brave, you make the call! Otherwise, you're allowed to order a brown stain or two . . .
I'll let the suspense build overnight😎
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Can't resist sharing this slide from my retiring colleague Leslie Bruch's great talk "Career Advice Top Ten: From Lessons Learned in My Own Career & Years of Mentoring."
I'm 18-yrs from starting residency; many of these come naturally; others are a struggle; all are important.
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65-year-old man with no significant PMHx undergoing surveillance colonoscopy (for polyps).
Incidental finding of 4 and 3 mm ulcers in ascending & transverse.
This consult came from the referring pathologist as "rule out Crohn's."
Diagnosis? Work up?
#PathologistAsHero
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Case of the Day: DNA MMR IHC on a recent consult . . . a colon cancer. How would you interpret the results of these stains and what's the next step in your workup???
#PathTwitter
#CAPVirtualPath
@UIPathology
@ISIMMweb
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Pulse granulomata in a case of perforated diverticulitis-- A peculiar "ribbony" reaction to organic foreign material, which I've seen mistaken for parasite or amyloid.
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I really do have the most interesting consultative practice😂😂😂
More to come from … this non-amyloidogenic lesion …
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Two things that make me happy😊😊😊
Incidental finding (of course) in my last new case of the day . . . an appendectomy . . .
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Triplets … fraternal😂😂😂
I’m the proud papa of a bag of platelets, plasma, and packed cells.
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Case of the Day: Woman in her 7th decade with endometrial cancer. How would you interpret results of MMR IHC? What's the next step in the workup?
@JackieHechtman
, I promise to quote your paper in my discussion, if you hold your tweet for a day😜😜😜
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You guys are too smart!!! I thought this was a pretty good mimic of an HNF1α-inactivated adenoma.
As Henry Frierson would say, "Call it whatever you want, just don't call it carcinoma."
I like "clear cell myomelanocytic tumor," but I'm old-fashioned.
Case of the Day? 30ish-year-old woman on oral contraceptives with 2 cm liver tumor. For the brave, you make the call! Otherwise, you're allowed to order a brown stain or two . . .
I'll let the suspense build overnight😎
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A
#CAP22
highlight: connecting with the incomparable
@TristanRutland7
… while
@SingleyRachel
and
@ReneeRutland5
commiserated about our collective dorkdom😂
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Transplant liver biopsy. Recent transplant. One hepatologist had Tylenol toxicity at the top of their differential, another had . . . what I ended up calling this.
What is this and why isn't this acetaminophen toxicity?
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Penny for your thoughts: diagnosis? work up? clues to diagnosis?
Ileal lesion in a gentleman just a few years older than me.
No tricks.
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Happy Friday,
#PathTwitter
!!! Please like, comment, & retweet.
I'm currently reviewing applications for our 2024-2025 GI Pathology Fellowship
@UIPathology
.
I'm clearly biased, but I consider it to be the best GI Path Fellowship in the world🥰🥰🥰 (1/3).
.
@ihcui_87
.
@KStashMD
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I'm thrilled to announce the 2024 Applied Immunohistochemistry and Molecular Morphology Retreat--January 25-28 in Key Largo.
I'll be sharing the podium with a legendary cast.
Register here:
Here's a link to the hr-by-hr schedule:
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Today, I got triggered.
I dashed off a venty email.
And then, instead of hitting send …
I deleted it.
I felt better.
And I wasn’t an asshole (at least in that one moment😂😂😂)
Holy shit … personal growth?!?!
Honestly … I’m incredulous😜😜😜
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I am saddened by the untimely passing of Sherif Zaki, Chief of ID Pathology at the CDC.
He was a pathologist’s pathologist—my indispensable go to for infectious disease IHC.
An inspiring read about a life well-lived …
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Because somebody needs this stuff more than I do …
And always a restful, meditative hour or two …
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It's official . . . I'm a pediatric GI neuromuscular disorder pathologist . . . or at least I keep very good company😊
Kapur RP, Bellizzi AM, et al. Congenital Myenteric Hypoganglionosis. Am J Surg Pathol. 2021 Jan 22. doi: 10.1097/PAS.0000000000001670. PMID: 33492848.
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Case 3: Not a stumper: just a neat IHC observation that I have found to be be very useful.
Subject: large vessel invasion (in colon cancer).
Can be hard to see; there is a nice literature that doing VVG increases the detection rate (Tweet 1 of . . . not sure yet😊😊😊).
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Always the last to know! Tidying up my GI med school lectures this week & learning all kinds of stuff.
Did you know, Clostridium difficile is no more? It's Clostridioides difficle!
Here's the skinny:
Note to self: I gotta start publishing in Anaerobe!
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Here's a fun game.
I just validated this stain.
What is it and why?
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I’m so delighted to have learned that our exemplary GI Pathology Fellow,
@IAbukhiran
has signed his contract with
@upmc
—a Department that I have such warm feelings about.
Looking forward to watching him and his family flourish in this next phase of his career and life.
في صحتك
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Calling on the collective wisdom of
#PathTwitter
.
What's at the center of this ileal granuloma? It's round, regular, a bit lamellated, has a pinhole in the middle, and polarizes around it's periphery. It's 12 microns across.
I postulated a fiber from a scrub or grill brush.
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Congrats to Sean, who is crushing it in GU Pathology and is an all-around great guy!!!
We are delighted to award Sean Williamson (
@SeanWilliamson_SR
) the 2024 APSS Annual Prize!
This award recognizes significant career achievements by a Surgical Pathologist under age 45, whose publications have had a major impact on diagnostic pathology.
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I'm proud to announce that the
@UIPathology
SP Fellowship w/ GI Emphasis is again participating in the
#UnifiedApproach
for the 2025-6 interview season; thrilled to be recruiting my 10th fellow! Thanks to
@PaulStaatsPath
for heading this national effort.
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#Tweeps
, I've had a breakthrough😊
Unsolved mystery solved ... no thanks to Google.
MIB 1 (the dominant Ki-67 clone) stands for Molecular Immunology Borstel 1 (because of course it does).
Score one for never stop reading.
See this tribute to J. Gerdes: DOI: 10.1111/his.13511
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Hi Folks, headed out for a week on the lake in Northern Minnesota. Wanted to let trainees know that I'm bringing along completed GI Path Fellowship applications for our '23-24 spot. Hoping to begin offering interviews ASAP. Great training in GI & IHC.
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In the spirit of message alignment,
#HAPPYSTPATHMATCHRICKSDAY
#PathMatch2023
#happysaintpatricksday
#dadjokes
I feel the expectancy of the Christmas mornings of my early youth.
In a few hours we’ll rip open all these presents to find out where gifted, passionate folks will have found their homes for the most exciting phase of their career.
Merry/Happy Match Day🥰🥰🥰
#PathMatch2023
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This PAX8 has me feeling a bit "on edge" this afternoon . . .
By the way, we believe IHC edge artifact is due to reagents getting trapped under the edges of tissue (which can be more loosely adherent to the glass slide) and then not washed away in subsequent steps.
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If I close the door, all this madness goes away, right?!?!?
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I made a new friend at signout today. He cracks me up . . . such a hoot . . .
@LizaMQuintana
@SingleyRachel
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Double platelet and a jumbo plasma! I’m as happy as a clam, as pleased as a peach … and ready for bed😂😂
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I love all my children equally but WHOA do we have a treat for you! Please join us tomorrow morning @ 11 ET for our next ISIMM webinar: a
#gynpath
extravaganza.
@AnneMillsMD
: MMR/PD-L1
@BrookeHowittMD
: mesenchymal tumors
Jaclyn Watkins: vulvar pathology
Matt Quick: endometrium
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Today, during a mindfulness exercise, my therapist instructed me to travel to a place of sweetness … and I ended up here …
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Delighted to host
@ZhaiJim
@UIPathology
for a resident slide session and Grand Rounds in salivary gland tumors tomorrow.
This evening he regaled us with wit and wisdom regarding lives well lived.
Jim is a gentleman, scholar, and dear friend.
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SMAD4 loss highlighting mucosal cancerization by underlying pancreatic ductal adenocarcinoma.
Bumped into this dandy while reviewing potential IHC control material.
The medical director's work is never done.
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While we all get settled in in New Orleans (well, everybody except me😂), I wanna take a moment to recognize the AP behind the scenes heroes. Happy
#HistotechnologyProfessionalsDay
Pat and Melissa put these sweet treats together & Akram and Moka keep me flush with GI biopsies.
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I'm thrilled to announce our upcoming
@ISIMMweb
webinar: Wednesday, January 18th, 11 am ET.
@MGHPathology
's Rex Hung will present "Diagnostic Applications of IHC in Thoracic Pathology."
Here's the registration link:
I'll be hanging on his every word😊
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An abundance of riches: assembling this team is my proudest professional accomplishment. Tonight we celebrated our fellow
@MattGosseMD
, joining us in July. Anthony has been my partner from nearly the beginning. I recruited Rossy for yrs. Dustin/Yiqin are completing their 2nd yr.
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Gastroenterologist-directed consult.
Endoscopically abnormal.
Signed out as "no histologic abnormality."
What did the GI doc see and what's the diagnosis?
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50-year-old man with maculopapular rash involving palms and soles.
What histochemical stain was requested?
What IHC stain would you like to request?
Diagnosis?
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Please give a thunderous welcome to
#PathTwitter
to my
#brotherbyanothermother
... a man who has his own
@Wikipedia
page for crying out loud ... the incomparable J.L.H.
@TheUSCAP
@AJSPjournal
@BrighamWomens
@RhondaYantiss
@johnhart20
@Vik_deshpandeMD
@Teclis82
@Chucktowndoc
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The most epic
#MOTTIRL
ever.
Chromogen siblings unite.
We FaceTimed with our other brother shortly thereafter.
#USCAP2022
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@marklewismd
Have you seen this one???
Of all the things that make me furious about my career, academic publishing is on the short list.
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@smlungpathguy
@slusagar
@Path_Matt
@DrFNA
@NRiddleMD
@FionaMacPath
@bluehatcomics85
@ALBoothMD
@MGBayerl_MD
@Janiranavarro
I learned 8 new ways to say no . . . and I have a new
#wallhanger
!
The Mydtskov criteria especially resonated with me.
I now know why everyone wants to do a project with me, as I tick off criterion
#3
rolling out of bed every morning😂😂😂
#USCAP2022
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Older man w/ "white plaque-like lesions" coating entire esophagus. I seem to recall
@LizMontgomeryMD
referring to this as the most "underdiagnosed lesion in GI pathology" (perhaps it was Henry?)
@JLHornick
refers to this as "clear cell squamous papilloma." No h/o malignancy.
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Thrilled to welcome everyone to tomorrow morning's (11 am ET)
@ISIMMweb
webinar in which my brother by another mother,
@JLHornick
, will regale us with tale after tale of sarcomas solved by next-generation IHC.
Link to register:
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I had inherited this slide 7-years ago and these folds had made me cringe every time I gave this talk.
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@AnAtomicPath
@smlungpathguy
IMHO, every nucleus counts. The amount of Ki-67 in the nucleus is variable throughout the cell cycle and is lowest in G1. More “lightly optimized” Ki-67 assays highlight the dynamic range of expression … while with “saturated” ones nuclei are uniformly strongly brown.
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After cooking Indian food the last two nights (butter chicken Monday, followed by aloo gobi and saag paneer Tuesday … for my little vegetarian) … I am suffering from a severe case of tumeric claw😊😊😊
@SingleyRachel
says … next time … paper plates😂😂😂
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Hot off the presses.
Pointing everyone to an incredibly timely CAP Center Guideline addressing MMR/MSI testing to select patients for checkpoint inhibitor therapy.
Kudos to the Expert Panel for their diligent work. It takes a village.
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I'm writing to invite all you
#hematomaniacs
to join tomorrow @ 11 am ET for our next ISIMM webinar.
@hemepathguy
will present "A Neoclassical Evaluation of Classical Hodgkin Lymphoma."
Turns out . . . Reed-Sternberg cells are devious!
Registration:
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I’m thinking of founding a new journal called … “Failed IHC Projects: Don’t Try This Again” …
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Next Generation Immunohistochemistry Strikes Again!!!
Kudos to Dr. Charville's Team!!!
DDIT3 Immunohistochemistry Is a Useful Tool for the... : The American Journal of Surgical Pathology
@JMGardnerMD
@MArnold_PedPath
@sanamloghavi
@DennisOMalleyMD
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I couldn’t be more proud of my former fellow and current UPMC faculty
@IAbukhiran
, while his faculty mentor slums it in the back row.
Oh yeah, and that’s my pal Andy Evans hanging over my shoulder.
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One week on
#Twitter
, and I’m exhausted. I remarked to the residents at our (
#socialdistanced
) signout that, “Twitter is really difficult.”
@shrockmd
commented, “You don’t have to go after it so hard.” I just chuckled😊😊😊
#whatsatwitter
#pathtwitter
#inittowinit
#gobigorgohome
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A visually arresting classic example presented this morning at
#MitrosConference
.
Too pretty not to share . . .
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Hello … Everyone.
Where do I belong and what should I be doing???
I’m asking very earnestly.
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Although the official Stellabration is on hold for virologic considerations, three cheers to another
@TheUSCAP
abstract deadline in the books.
Thanks to all my great teammates for dragging me across the finish line😂
-Another year
-Another
@TheUSCAP
Abstract Deadline (Ian be damned … I’m done)
-Another Stellabration (
@StellaIowaCity
)
-Another stupid hat😂😂😂
To my brothers & sisters in the trenches, I salute you.
To my brothers & sisters in the Gulf, batten down the hatches & stay well.
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A dear friend and colleague, who is advocating for me in a professional setting, just wrote me a message that stated, in part:
“You probably do not recognize how excellent you are.”
If only, my friend. I am printing out the email and taping it to my refrigerator😂😂😂
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The histology of even the most "mundane" pathologies is often stunningly beautiful.
Focal ischemic myopathy in a sigmoid volvulus auditioning for a spot on the wall.
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I'm inviting all the coolest kids on
#PathTwitter
(that means you!) to my 5-day IHC Retreat, July 23-27 in beautiful Montreal.
I'll be sharing the podium w/ an All Star Cast!
Register here:
Here's a link to the hr-by-hr schedule:
It's about time for me to be "over the moon" again.
It's all come together for our in person Applied IHC and Molecular Pathology retreat scheduled for July 23-27 at the Hotel Bonaventure in Montreal.
Registration scheduled to open FRIDAY and hope to see many of you there (1/2).
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I think this turned out pretty legit. Happy Thanksgiving to you and yours and here’s to a brighter 2021!!!
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Point very well taken, though I use WT-1 for that application. Beautiful photomicrograph!!!!
I DO use vimentin in the endometrioid vs endocervical adenocarcinoma differential as part of a panel. Don't tell anyone; it'll be our little secret.
#everydoghashisday
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JLH, my brother by another mother, is a
#NextGenIHC
trailblazer. Happy to ride his coattails publishing on novel SS18-SSX IHC in
@AJSPjournal
last month:
As Ron Swanson says, "
#FISH
-for sport only; fish meat is practically a vegetable."
#CAPVirtualPath
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