Case of the Week
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Case History
A 66-year-old female with right middle lobe lung lesion (A Sox10 immunostain was negative).
What is the diagnosis?
- Granular cell tumor
- Plasmacytoma
- Crystal-storing histiocytosis
- Carcinoid tumor
Case contributed by: Carlos Prieto-Granada, M.D, Assistant Professor, Anatomic Pathology, Dermatopathology Section Head
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Case History
A 56-year-old female underwent upper endoscopy for dyspepsia. A 1 cm gastric nodule was found and biopsied. The histological findings are shown in Figure1 (low power) and Figure 2 (high power). Synaptophysin immunostaining of the tumor (Figure 3) and the background mucosa (Figure 4) are included.
What is the diagnosis?
- NET, type 1
- NET, type 2
- NET, type 3
- NET, cannot be classified
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Case History
A 35-year-old male with an excision for anal condylomas. What is the underlying infectious agent?
- T. Palladium
- Human Immunodeficiency virus
- High-risk Human Papilloma Virus
- Low-risk Human Papilloma Virus
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Case History
A 28-year-old man with a history of neurofibromatosis type 2 (NF2) experienced a five month history of progressive bilateral upper extremity hemiparesis. Neuroimaging studies demonstrated a 4 cm enhancing intramedullary mass located at cervical spinal level 3 (C3).
1) The most common intramedullary spinal neoplasm in this clinical setting is:
- Schwannoma, WHO grade I
- Pilocytic astrocytoma, WHO grade I
- Diffuse astrocytoma, WHO grade II, IDH1 mutant
- Anaplastic astrocytoma, WHO grade III, IDH1 wild-type
- Ependymoma, WHO grade II
2) The characteristic location of the NF2 gene is in chromosome region:
- 22q12
- 2
- 3p25-26
- 9q
- 16p
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Case History
The patient is a 23-month-old female with status post liver transplant one month ago due to biliary atresia and shows newly elevated liver function test. The liver biopsy is performed and the histological findings [Figure 1 (medium power at upper right corner) and Figure 2 (high power at lower right corner)] are below.
What is your diagnosis?
- Acute cellular rejection
- Histoplasmosis
- CMV infection
- Adenovirus infection
- HSV infection
- Centrizonal necrosis due to ischemia
Figure 1. Low power shows multiple inflammatory foci within the lobule. The inset (medium power at upper right corner) shows spotty necrosis/apoptosis with nuclear debris and inflammatory cells consisting of histiocytes, lymphocytes, and rare eosinophils.
Figure 2. Nuclear inclusions within the hepatocytes are present at the edge of an inflammatory/necrotic focus. The inset (high power) at lower right corner reveals glassy or smudgy nuclear inclusions with central eosinophilic appearance.
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Case History
An 70-year old male reports having a parotid mass for years. In the past year, it has grown rapidly and extended to his skin. Representative sections are shown. Tumor cells are positive for DOG1 and negative for androgen receptor, mammaglobin, and p63.
What is the diagnosis?
- Adenocarcinoma, NOS
- Acinic cell carcinoma, with high-grade transformation/dedifferentiation
- Salivary duct carcinoma
- Adenoid cystic carcinoma, with high-grade transformation/dedifferentiation
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Case History
A 53-year-old female presents with tonsil mass. What is the next step?
- Sign out; clinical staging evaluation needed to further characterize.
- Depends on the clinical history.
- Perform additional IHC/ISH.
- Perform additional IHC/ISH and molecular studies.
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Case History
A 52 year-old asymptomatic woman was found to have nephrotic range proteinuria, mild hypoalbuminemia, and normal renal function. A renal biopsy was performed. H&E, silver stain, Congo red stain, lambda and kappa light chains immunofluorescence are shown. Remaining IF negative.
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Case History
A 35-year-old G3 P2022 mother was transferred to UAB for induced vaginal delivery at 37 weeks due to intrauterine fetal demise. Post-mortem evaluation demonstrated a mildly microcephalic but otherwise nondysmorphic, hydropic female fetus. The brain weighed 201 g (268-412 g expected). There was ventriculomegaly, periventricular necrosis, calcification and hemorrhage.
Based on the above image, what is the most likely diagnosis?
- Intrauterine stroke
- HSV infection
- Germinal matrix bleed
- CMV infection