7/9
Look at these numbers.
65% of patients had tumor shrinkage on tucatinib + trastuzumab. Median OS: 24.1 months (95% CI 20.3–36+).
For context — standard salvage chemo in the same line gives ~6–7 months
These aren't abstract statistics. This is what HER2 testing can unlock 👆
6/9
Good news: there are now real options 🎯
FDA approved two regimens for HER2+ mCRC:
— tucatinib + trastuzumab (MOUNTAINEER, 2023)
— trastuzumab deruxtecan / T-DXd (DESTINY-CRC02, 2024)
(old but gold picture)
🧵 1/9
Elderly male. Metastatic colorectal cancer with liver mets. RAS wild-type — looks straightforward.
Then the molecular profile comes back: HER2 IHC 3+.
This changes the entire treatment plan. Here's why 👇
2/6
H&E shows sheets of clear cells with abundant pale cytoplasm, small uniform nuclei, and a prominent vascular pattern. Your differential? 🤔
Clear cell hidradenoma? Sebaceous carcinoma? Something else entirely?
🧵 1/6
A nodule on the face. Sent as a skin biopsy. No clinical history provided. Spoiler: this is NOT a primary skin tumor. 👇
#pathtwitter #dermpath #uropath #pathology
🧵 Not all breast carcinomas are created equal 🧬
Here's how p63 expression shifts as tumors progress toward a basal/stem-cell phenotype👇
#pathtwitter #breastpath #pathology

ALT Illustrated diagram showing p63 expression across three breast tumor types. Tumor 1 (G1/G2 NST): uniformly blue cells, p63-negative. Tumor 2 (G3 NST): predominantly blue cells with scattered brown cells, p63-positive, triggered by TP53 mutation. Tumor 3 (Metaplastic carcinoma): predominantly brown cells, p63-strongly positive. An arrow along the bottom indicates increasing basal program activation, aggressiveness, and stem-cell phenotype from left to right.
Gastric biopsy — almost called it poorly differentiated carcinoma. Lesson learned: always dig deeper on low-grade gastric tumors.
Turned out to be metastatic melanoma. Patient had a history of melanoma. Never skip the clinical context. 🔬
#pathology #pathtwitter #gipath
Metastasis of goldfishoma to lymph node 🐠 #pathtwitter #pathart
Phyllodes tumor of the breast with liposarcoma. Beautiful bizarre cells! 👻 #pathtwitter #breastpath
So cute and classic molluscum contagiosum 🌸
#pathtwitter #dermpath
Hemangioma in the pelvic lymph node, an incidental finding.
#pathtwitter #hemepath
Patient with tuberculosis in anamnesis. Gray nodule from the periphery of the lung, d 2 cm. Thick fibrous capsule on the outside, necrosis on the inside. Inside the capsule a lining of atypical cells + lymphovascular invasion. #pathtwitter #lungpath #pulmpath
This is what a pathologist looks like according to the neural network :) #pathtwitter #pathart #midjourney



































