Case of the Week
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Case History
A 50 year old male presents with a 9 cm retroperitoneal mass who had a resection of 16 cm fatty retroperitoneal mass 10 years prior.
Which of the following will show diffuse positivity in this tumor?
- S100
- SMA
- MDM2
- Desmin
Case contributed by Scott Taylor, M.D., Surgical Pathology Fellow, UAB Department of Pathology
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Case History
A 62-year-old- male with a history of multiple skin cancers presents to an ENT for a newly discovered firm mass adjacent to his right nasal ala. After biopsy, the mass is resected (Fig A-D).
This tumor is most likely to stain positive for:
- CEA
- Adipophilin
- S100
- Ber-EP4
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Case history
71-year-old male veteran presenting with hematuria. Two ulcerated lesions identified upon gross examination. The diagnosis is:
- Plasmacytoid variant of urothelial carcinoma
- Plasmacytoma
- Melanoma
- Metastatic signet ring cell carcinoma
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Case history
A patient presents with extrahepatic cholangiocarcinoma, a biopsy of the liver shows the following:
What stain is most likely to be the most helpful to make the diagnosis?
- Ki-67
- CK7
- Arginase
- No additional stains needed
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Case history
An 84-year-old woman presents with a mediastinal mass. Representative sections are shown.
What is the diagnosis?
- Solitary fibrous tumor
- Small lymphocytic lymphoma
- Thymoma, Type A
- Thymoma, Type AB
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Case history
Placenta from a 33-year old P0 mother delivered at 25 6/7ths weeks. Maternal history of scleroderma. Fetal intrauterine growth restriction (<5th %ile).
Finding shown are characteristic of:
- Cytomegalovirus infection
- Chronic villitis of unknown etiology
- Massive perivillous fibrinoid deposition
- Chronic histiocytic intervillositis
- Listeria monocytogenes villitis
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Case history
A 76-year-old man with a history of HTN and CKD Stage III presented with increased serum Cr. Renal biopsy performed showed cellular and fibro-cellular crescents with fibrinoid necrosis by LM (Jones silver, Fig a & b). IF and EM were negative.
Which of the following information, based on LM findings, is helpful in making the diagnosis?
- . Anti-dsDNA titer
- . ANCA titer
- . Anti-GBM antibodies.
- . All of the above.
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Case history
A 36 year old man presented to an OSH for an upper GI bleed. Biopsy was non diagnostic. He was referred here for EUS-FNA. US showed an 11 mm. hypoechoic submucosal mass in the lesser curvature (Fig 1). EUS-FNA smear stained with Diff-Quik is moderately cellular (Fig 2-4).
Diagnosis:
- Gastric adenocarcinoma
- Endocrine neoplasm
- Pancreatic heterotopia
- Epithelioid GIST
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Case history
A pancreatic head mass was discovered in a 50-year-old man with chronic pancreatitis. Grossly, the lesion was ill-defined and notable for obstructing the main pancreatic duct while the common bile duct and ampulla were probe patent. The patient noted a mother who died of pancreatic cancer at 55 and that he’s been hospitalized for pancreatitis several times since his 20s. What is the underlying tumor and which of the following genes is not associated with hereditary pancreatitis?
- Pancreatic ductal adenocarcinoma, Mothers against decapentaplegic homolog 4 (SMAD4)
- Cholangiocarcinoma, Cystic fibrosis transmembrane conductance regulator (CFTR) mutations
- Acinar cell carcinoma, Serine protease inhibitor Kazal type 1 (SPINK1) mutations
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Case history:
This is a biopsy from the olfactory cleft (skull base) in a 71-year-old woman with rhinorrhea. Endoscopically there is a small nodule.
What is the diagnosis?
- Reactive stromal spindle cell proliferation
- Respiratory epithelial adenomatoid hamartoma
- Biphenotypic sinonasal sarcoma
- Solitary fibrous tumor