Case of the Week

An 81-year-old female with a skull base tumor. Which ancillary test will clinch the diagnosis?

1.       s100 protein expression
2.       MART1 expression
3.       Artginase expression
4.        An immunostain for INI-1

A 36-year-old HIV+ male with left retroperitoneal adenopathy. Prior h/o sepsis and negative excisional biopsy. What is the diagnosis?

1.      Metastatic carcinoma
2.      Lymphoproliferative neoplasm
3.      Infectious lymphadenidits
4.      HIV lymphadenitis

A 35-year-old female with multiple cutaneous lesions that show these histopathologic features. This patient should be screened for a germline mutation of which gene and will likely develop which types of tumors in addition to the one displayed here?

1.         BHD, renal cell carcinoma, fibrofolliculoma, trichodiscoma
2.         PTCH1, basal cell carcinomas, medulloblastoma
3.         SDHB, pheochromocytomas, paragangliomas
4.         FH, renal cell carcinoma, uterine leiomyomas

A 74 -year-old woman with a clinical history of dementia dies at home. The family wishes to clarify the history of dementia. An autopsy shows cortical atrophy and ventriculomegaly. Based on the 3 images taken from sections of frontal lobe, what is the most likely diagnosis?

1.        Dementia with Lewy Bodies
2.        Vascular dementia
3.        Alzheimer dementia
4.        Frontotemporal dementia

A 79-year-old Caucasian male was diagnosed with CLL in 8/2011. His CT revealed splenomegaly and some borderline enlarged nodes. One in the left axilla was 1.4cm. In January, 2017, his CT showed mild progression of his nodes. The largest one was left external iliac lymph node 3.4 x 1.2 cm, with a 1.4 cm increase over 13 months. In March 2019, he developed cough, chest X-ray reveal bronchial changes.  In several month, he also developed peritoneal fluid.

What is the diagnosis?

A: Reactive mesothelial cells

B: Lymphoma

C: Melanoma

D: Mesothelioma

A 52-year-old female presents with long standing pruritic rash and dyspnea. No history of allergies or EpiPen use. CBC within normal limits. Now with bone marrow biopsy. 

What is your diagnosis? 

A. Mast cell hyperplasia.

B. Systemic mastocytosis.

C. Mast cell leukemia.

D. Lymphoplasmacytic leukemia.

A 21-year-old female presented with anemia and thrombocytopenia. MRI of the abdomen performed demonstrated a rounded well-defined 5.9 × 7.8 × 8.1 cm anterior subcapsular mass present within the spleen. Laparoscopic hand-assisted splenectomy was performed.

What is the best diagnosis?

1.       Hamartoma of spleen
2.       Angiosarcoma
3.       Sclerosing angiomatoid nudular transformation of the spleen (SANT)
4.       Littoral cell angioma

A 55-year old female underwent CT of the abdomen for renal transplant evaluation revealing a 3.3 cm right renal lesion and a 3.2 cm soft tissue mass in the right celiac region. The soft tissue mass was biopsied. What is your diagnosis?

1.        Leiomyoma 
2.        Schwannoma
3.        Gastrointestinal stromal tumor
4.        Solitary Fibrous Tumor

A 32-year-old female, with a history significant for tuberous sclerosis, presents with dyspnea. CT imaging demonstrates diffuse bilateral nodular and cystic changes in the lung parenchyma. A wedge lobectomy is received.

Which of the following immunohistochemical stains would best confirm your diagnosis?

Answer choices: 

1. HMB45, SMA
2. SMA, desmin, caldesmon
3. STAT6, CD34
4. CD117, DOG1