Case History

27-year-old female with incidentally discovered 9.4-cm left lobe liver mass on MRI. There is no underlying liver disease, and the background liver is non-cirrhotic. Serum AFP is normal. Hepatitis panel is non-reactive. 

What is your best diagnosis?

  1.         Focal nodular hyperplasia
  2.         Fibrolamellar hepatol cl ca
  3.         Hepatolcellular ca
  4.  Cholangiocarcinoma

  Case of the week 2    March week 3 photo 3  March week 3 photo 4

Case History

A 35-year-old with a unilateral pelvic mass.

What is the likely diagnosis? 

  1.        Endometrioid carcinoma
  2.        Carcinoid tumor
  3.        Sertoli–Leydig cell tumor
  4.        Metastatic carcinoma
  5. Granulosa cell tumor

Blood.jpg  Case of the week 2    Aspirate.jpg

Case History

A 48-year-old male with facial flushing was found to have atypical cells in both the peripheral blood (<1%) and bone marrow (50% on aspirate differential). Based on the provided photos and flow cytometry, which of the following is the best diagnosis?

  1.       AML with t(8;21)
  2.       CML
  3.       AML with inv(16)
  4. Mast cell leukemia (aleukemia variant)

Blood.jpgBlood    Aspirate.jpgAspirate

Flow.pngFlow    MarrowBiopsy.pngMarrow Biopsy

Case History

A 58-year-old male with a liver and omental mass. Omental mass biopsy shows:

  1.       Signet ring cell carcinoma
  2.       Ex Goblet cell carcinoid/Goblet cell adenocarcinoma
  3.       Epithelioid Hemangioendothelioma
  4.       Angiosarcoma
 EH ERG2EH ERG2  EH keratinEH Keratin
    EH omentum 4xEH omentum 4x EH omentum 20xEH omentum 20x

Case History

A 63-year-old female with uterine mass and postmenopausal bleeding

What is the diagnosis:

  1.       High-grade serous carcinoma
  2.       Carcinosarcoma
  3.       Undifferentiated endometrial sarcoma
  4.       Adenosarcoma with sarcomatous overgrowth
 Question Photo 1Uterine tumor  Vimentin +
    Question Photo 3CK LMW (CAM 5.2+) 

Case History

A mid 60’s-year-old male with metastatic prostate cancer presents with dysphagia and chest pain. An upper gastrointestinal endoscopy reveals few superficial esophageal ulcers, 27 to 32 cm. The biopsy findings shows in the Figure A (H & E, 20) and Figure B (high magnification, x40) and Figure C (polarizing microscopy). What is your diagnosis?

 

  1.       Inadequate specimen
  2.       Fungal esophagitis
  3.       Pill esophagitis
  4.       Foreign body
 Question Photo 1Fig. A: Endoscopic biopsy (H&E Stain, X20)  Fig. B High Magnification x40Fig. B High magnification (x40)    Question Photo 3Fig. C: Findings under polarized light 

Case History

A 61 year-old man with no other significant medical history presents with a nasal region mass. The biopsy is shown. Which of the following is a documented risk factor for the lesion?

  1.       Asbestos exposure
  2.       Wood dust exposure
  3.       Smoking
  4.       HPV infection 
 Question Photo 1   Question Photo 2   Question Photo 3
 

Case History

28 year-old male with inguinal lymphadenopathy. IHC shows many CD15-, CD30+ large cells. CD20+ and CD3+ large cells seen. Background lymphocytes mostly T-cells with inverted CD4/CD8 ratio. Ki-67 elevated throughout infiltrate. EBER shows scattered + cells.

  1.       EBV+ classic Hodgkin lymphoma
  2.       Acute EBV infection (infectious mononucleosis)
  3.       EBV+ PTCL
  4.       EBV+ DLBCL, NOS 

Case History

A 30 year-old man presents with progressive left side weakness. Imaging shows a right parietal lobe cystic lesion. Testing of the surgical resection specimen demonstrates negative IHC staining for IDH1 (R132H). FISH test is positive for 1p/19q codeletion. What is the next step?

 

  1.        Sign out as diffuse astrocytoma, WHO grade II.
  2.        Sign out as anaplastic oligodendroglioma, WHO grade III.
  3.        Submit for sequencing (NGS) to confirm IDH status.
  4.        Submit for fusion gene panel.