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A 65-year-old male presented with abdominal pain and 4-5 pounds weight loss, but no biliary obstruction. His extensive workup revealed gastritis and a mass in the head of the pancreas, 2.7 cm. Outside BX reported to be a tumor mucinous in character. The patient underwent proximal subtotal pancreatectomy with a Whipple procedure.

What is your diagnosis of this case?

  1. Multiple myeloma
  2. Autoimmune pancreatitis (AIP), type 2
  3. Inflammatory bowel disease/CD involving the pancreas
  4. IgG4-related sclerosing disease (IgG4-RSD)

Case contributed by Sameer Al Diffalha, M.D., Assistant Professor, Laboratory Medicine

 Picture1Tumor is grossly involving uterine serosa Picture2Myometrium with lymphovascular tumor invasion 
  Picture3Detail of tumor with cellular perivascular areas  

Clinical history:

49 year-old-female with pelvic mass and diffuse pulmonary lesions

Gross examination:

Tumor is present in the uterus and surrounding tissue (“pelvic mass”), total size 19.0 cm

Microscopic examination:

Tumor within myometrium with stromal and lymphovascular invasion and in “pelvic mass”. No mitoses are identified.

Immunohistochemical stains:

                -Positive: ER, PR, SMA, desmin, HMB-45, MiTF

                -Negative: CD10, CK LMW (CAM 5.2), CK HMW (34BE12), DOG1.

Choose the correct diagnosis:

  1. Endometrial stromal sarcoma
  2. Perivascular epithelioid cell neoplasm
  3. Intravascular leiomyomatosis
  4. Gastrointestinal stromal tumor

 FIG 1 20x EBF sclerosis plasma cells Fe FIG 2 FVM Fe sclerosis Ca2 high power 
  FIG3 4x image with edema NIH  FIG 4 inclusion low power

Clinical History:

17-year-old primigravida with delivery of live born infant at 31 weeks gestation. Gestation complicated by non-immune hydrops (NIH) of unknown etiology, and severe preeclampsia. Placenta 526 g (269 - 411 g exp). What is the most likely cause of the NIH?

    1. Rh-isoimmunization
    2. Herpes Simplex Virus
    3. Listeria monocytogenes
    4. Cytomegalovirus
    5. Toxoplasma gondii

 testis 

Clinical History:

A 13-year-old male undergoes orchiectomy for a testicular mass. Ultrasound shows an onion-skin like pattern to the mass. Histology show a squamous cyst with keratin debris. You want to decide between a prepubertal (benign) and postpubertal (malignant) teratoma. What is the next molecular study you will perform? 

A.       12p amplification
B.        Isochromosome 3p
C.        EWSR1 translocation
D.        Xp11.2 translocation
E.        MET gene mutation

Fig A Fig B

Fig C Fig E

Clinical History:

A 71-year-old man with long standing history of hypertension presented with increased serum creatinine of 3.4 mg/dL, detected during routine laboratory examination, with no associated symptoms. He was eventually seen by a nephrologist. A kidney biopsy was performed. The biopsy findings are shown in the following figures (Fig A & B: PASH stain, Fig C: Lambda- immunofluorescence stain, Fig D: Kappa- immunofluorescence stain and Fig E: Electron Microcopy of the proximal epithelial cell cytoplasm).

Based on the morphologic features the correct diagnosis is:

  1. Non-specific protein resorption droplets.
  2. Light chain cast nephropathy.
  3. Isolated light chain proximal tubulopathy without crystal formation.
  4. Isolated light chain proximal tubulopathy with crystal formation.

1 

Clinical History:

A 35 year- old female not known to be immunocompromised present with abnormal Pap test. She underwent colposcopic biopsy of suspicious cervical lesion.

A: What is the most likely diagnosis?

  1. Angiocentric lymphoma
  2. Hodgkin lymphoma
  3. Lymphoproliferative disorders
  4. Viral cervicitis

Picture1  Picture2 

Picture3  Picture4

Clinical History:

This 39-year-old Hispanic woman, a never smoker, underwent thoracotomy and pleurodesis for spontaneous pneumothorax in 2012.  A subsequent pneumothorax in 2014 resulted in a right upper lobe wedge biopsy (shown). She is asymptomatic except for shortness of breath when exposed to cigarette smoke. Recent radiographs show bilateral pulmonary cysts and new renal masses.

Which is the correct diagnosis?

  1. Chronic obstructive pulmonary disease (COPD)
  2. Adult polycystic kidney disease
  3. Birt-Hogg-Dube syndrome
  4. Lymphangioleiomyomatosis (LAM)

Picture1  

 1) A 45-year-old woman described increased fatigue over a period of 1 week and decided to get a doctor’s appointment after her spouse noted scleral icterus. Family history is notable for a maternal aunt with PBC. Her medical history was notable for cholecystectomy 5 months ago and detection of hookworm infection (treated with thiabendazole) 3 weeks prior to this clinic visit. Laboratory studies revealed elevated transaminases and total bilirubin. Liver biopsy revealed bland cholestasis with minimal mixed portal infiltrates. No ductular reaction or granulomatous inflammation were seen. What is her underlying condition?

Choose the Correct Diagnosis:

  1. Cholecystectomy related cholangiopathy
  2. Drug-induced liver injury
  3. Primary biliary cholangitis

Answer: B.) Drug-induced liver injury

EM 1 1   EM 2

IF  LM

Clinical History

The patient is a 73-year-old male with prostate cancer, HTN, hyperlipidemia and PE. Laboratory data from the outside hospital included: Cr 1.3, 24 hr protein 516, C3 196, C4 29, Sed rate 35, ANA negative. The specimen is a renal biopsy.

Choose the Correct Diagnosis:

  1. Amyloid
  2. Immunotactoid glomerulopathy
  3. Cryoglobulinemic glomerulonephritis
  4. Fibrillary glomerulonephritis

Slide1   Slide2 1

Clinical History

40 year old female with pelvic mass and friable cervix, biopsy was performed at OSH. Neoplastic cells positive for  CD20+, CD138+, MUM-1+, CD56+, EBER-/+, CD30-, HIV-. C-MYC deletion.

Choose the Correct Diagnosis: 

  1. Plasmablastic lymphoma
  2. Plasmacytoma / myeloma
  3. Large B-cell lymphoma
  4. Reactive/EBV-related neoplasm