Case of the Week
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Case History
Patient history:
The patient is a 75-year-old male who was found to have multiple liver lesions and malignant appearing peri-pancreatic lymph nodes by radiology. Diff-Quik stained smears from the endoscopic FNA of the liver are shown.
What is the diagnosis?
- Metastatic clear cell renal cell carcinoma
- Metastatic ductal adenocarcinoma of the pancreas
- Hepatocellular carcinoma
- Epithelioid hemangioendothelioma
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Case History
Patient history:
80-year-old female underwent biopsy for a 4.5 cm ulcerated mass in the sigmoid colon, followed by low anterior resection.
What is the diagnosis?
- Sessile serrated adenoma/lesion
- Traditional serrated adenoma
- Tubulovillous adenoma
- Hyperplastic polyp
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Case History
Patient history:
Patient is a 60-year-old male with a “bladder tumor.” Multiple nodules were present in the lung, liver and pelvic lymph nodes. A CT guided biopsy was performed, targeting the hepatic nodules. P40, synaptophysin and chromogranin are negative. MSI studies show loss of MLH1 and PMS2, with retained MSH2 and MSH6.
Which of the following statement is false?
- Metastatic prostate adenocarcinoma may show focal or strong staining for GATA 3.
- 1 is more sensitive and specific marker than PSAP in differentiating poorly differentiated prostatic carcinoma from urothelial carcinoma.
- MLH1 and PMS2 loss is increased in patients with a family history of prostatic cancer.
- BRAC2 mutation increases the risk of prostate cancer in men over 65.
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Case History
Patient history:
51-year-old male with a three-week history of 2.5 cm left parotid mass. H&E and IHC are illustrated. P63 and DOG1 were negative.
Which of the following is the correct diagnosis and the typical associated molecular changes?
- Adenoid cystic ca—MYB-NFIB
- MEC—CRTC1-MAML2
- Acinic cell ca—NR4A3
- Secretory ca—ETV6-NTRK3
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Case History
Patient history:
42-year-old male with hypoglycemia, altered mental status, and large skull-based mass with prominent veins. Diagnosis and genetics? (H&E and CD34)
What is the diagnosis?
A. Hemangioblastoma / Chromosome 3
B. Hemangiopericytoma / NAB2-STAT6 fusion
C. Hemangioma / GLUT1
D. Kaposi sarcoma / HHV8
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Case History
Patient history:
Patient is a 68-year-old female with a about 20 cm ovary mass. The mass has a mixed (solid/cystic) cut surface.
What is the diagnosis?
- A) Acute T cell-mediated rejection.
B) Antibody-mediated rejection.
C) Post-transplant lymphoproliferative disorder.
D) Polyomavirus nephropathy
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Case History
Patient history:
52-year old male received deceased donor kidney transplantation 6 month ago, end stage renal disease secondary to fibrillary glomerulonephritis. Creatinine has been fluctuating between 1.9-2.1 in recent 3 month (the baseline was 1.3 to 1.4). Recent donor specific antibody (DSA) test is negative, and other serologic tests are pending.
Question #1: Based on clinical history, pictures of chemical and IHC stains, which diagnosis is favored:
- A) Acute T cell-mediated rejection.
B) Antibody-mediated rejection.
C) Post-transplant lymphoproliferative disorder.
D) Polyomavirus nephropathy
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Case History
28-year-old male, zygoma mass, diagnosis?
- LG fibromyxoid sarcoma
- Chondromyxoid fibroma
- Chondrosarcoma
- Cellular myxoma
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Case History
A 36 y/o AA male with emphysema and tobacco use, and a new large paramediastinal mass, which underwent FNA. What is the diagnosis?
- Squamous cell carcinoma
- Poorly differentiated adenocarcinoma
- High-grade lymphoma
- SMARCA4-deficient thoracic sarcomatoid tumor
