On July 30, 2025, Pathologists’ Assistant Program student Cadey Cousins was awarded the American Association of Pathologists’ Assistants (AAPA) Travel Grant to attend the AAPA 50th Annual Fall Conference in Denver, Colorado Sept. 7-11, 2025. AAPA awards the travel grant to one second-year non-delegate pathologists’ assistant student. It covers registration and travel expenses for attending the conference. In addition, her winning article will be published in the AAPA journal, The Cutting Edge, later this year.
In her winning manuscript, titled “Extraskeletal Osteosarcoma of the Breast: An Uncommon Presentation of a Malignant, Rare Tumor and the Importance of the Pathologists’ Assistants in the Diagnostic Process,” Cousins discussed the importance of using acid-free decalcification solutions like ethylenediaminetetraacetic acid (EDTA) on bone tumors so that ancillary and molecular testing can be done to make a final diagnosis. EDTA, a chelating agent, binds to calcium ions and removes them from tissue without the harsh effects of strong acids. This results in a gentle decalcification of bone or calcified tissue, preserving cellular and tissue morphology for microscopic examination.
In this case, the pathologists’ assistant who was grossing the specimen made sure that there were non-decalcified tumor blocks, which allowed the pathologist to make a final diagnosis of extra skeletal osteosarcoma (ESOS). There had been some uncertainty with the diagnosis from the previous biopsy, called a vascular neoplasm, which is a type of tumor that arises from cells that form blood vessels or lymphatic vessels. ESOS is a rare type of aggressive cancer that accounts for one percent of all soft tissue sarcomas. It is even more rare when involving breast tissue.
In her manuscript, Cousins described the work-up of this case, including the immunohistochemical (IHC) stains that were ordered on the non-decalcified tumor block that helped narrow down the diagnosis. She was able to relate this discussion to the importance of the role of the pathologists’ assistant, who is responsible for the gross examination and documentation of crucial macroscopic elements (such as tumor size, distances to margins, and margin status) that ultimately helped to determine a definitive final diagnosis for the patient’s cancer and staging and determine appropriate treatment.
In addition to her winning manuscript, Cousins will also present a poster titled “The Pathologists’ Assistant’s Role in Bone Specimen Decalcification: A Case Study Involving Extraskeletal Osteosarcoma” at the AAPA Fall Conference. She plans to highlight the importance of using acid-free decalcification solutions like EDTA when pathologists’ assistants are grossing bone tumor specimens.
Duke Pathology’s Head of Bone & Soft Tissue Pathology, William Jeck, MD, PhD, was the case pathologist and pathologists’ assistant Jonathan Chen, MHS, PA(ASCP), grossed the case, took the macroscopic gross photographs, and also provided guidance to Cousins for her manuscript and poster.