Cytopathology in the Philippines is currently practiced by board-certified anatomic pathologists who receive only a three-month rotation in the discipline during their four-year combined Anatomic and Clinical Pathology residency training. At present, the country lacks a formal fellowship program in cytopathology, and no national core curriculum has been developed for this subspecialty. Local pathologists with advanced training and extensive experience in cytopathology recognized by the Philippine Society of Pathologists, Inc. (PSP) developed the first national core curriculum for cytopathology fellowship training. This initiative marks the first locally developed guideline for cytopathology fellowship training in the Philippines, representing a significant milestone in the advancement of subspecialty pathology education in the country.

This is a case of a 55-year-old female, surgical menopause for nine years, not on hormone therapy with one year history of a progressively enlarging left vulvar mass, who sought consult and subsequently underwent excision of mass. Microscopic findings showed alternating hypo- and hypercellular areas composed of plump spindle to epithelioid cells distributed in an edematous stroma with varying amount of collagen. Tumor cells have bland chromatin, inconspicuous nucleoli, and absent mitoses. The cells surround small to medium-sized thin-walled, hyalinized vessels found in hypercellular areas. An adipocytic differentiation of more than fifty percent of tumor is observed further classifying this neoplasm as lipomatous angiomyofibroblastoma, making this an even rarer type of benign mesenchymal tumor of the vulva. Immunohistochemistry stains performed showed positive staining for vimentin, smooth muscle actin, BCL-2, ER, PR, and negative staining for desmin which supports the diagnosis. The clinical presentation, operative findings, histopathologic features and the various considerations are discussed. Literature review of vulvar angiomyofibroblastoma is also presented.

Background: The diagnosis of thyroid neoplasms necessitates the identification of distinct histological features. Various education/hospital centers located in cities across Indonesia likely result in discordances among pathologists when diagnosing thyroid neoplasms. Methods: This study examined the concordance among Indonesian pathologists in assessing nuclear features and capsular and vascular invasion of thyroid tumors. Fifteen pathologists from different centers independently assessed the same 14 digital slides of thyroid tumor specimens. All the specimens were thyroid neoplasms with known BRAFV600E and RAS mutational status, from a single center. We evaluated the pre- and post-training agreement using the Fleiss kappa. The significance of the training was evaluated using a paired T-test. Results: Baseline agreement on nuclear features was slight to fair based on a 3-point scoring system (k = 0.14 to 0.28) and poor to fair based on an eight-point system (k = –0.02 to 0.24). Agreements on vascular (κ = 0.35) and capsular invasion (κ = 0.27) were fair, whereas the estimated molecular type showed substantial agreement (κ = 0.74). Following the training, agreement using the eight-point system significantly improved (p = 0.001). Conclusions The level of concordance among Indonesian pathologists in diagnosing thyroid neoplasm was relatively poor. Consensus in pathology assessment requires ongoing collaboration and education to refine diagnostic criteria.