Case History

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

  1.   pic1pic2pic3pic4

Case History

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.

  1.   image 1image 2image 3image 4

Case History

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
  1.   Question Photo 1Question Photo 2Question Photo 3Question Photo 4

Case History

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

  Cyto1 Cyto2 HE1 HE2

Case History

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

  Question photo 1 Question photo 2 Question photo 3 Question photo 4

Case History

A 58-year-old woman presents with a 4.7 cm ovarian mass. The patient has a history of smoking, HTN, and DM2.  No definitive crystals are seen in the tissue sections examined. IHC images are shown. 
What is the best diagnosis?
A. Leydig cell tumor
B. Clear cell carcinoma of ovary
C. Metastatic clear cell renal cell carcinoma
D. Steroid cell tumor, NOS

  Question photo 1 Question Photo 2 Question photo 3 Question Photo 4

Case History

A 50-year-old presents with multiple liver masses. Histologic examination reveals the following:

Figure 1:  Hyalanized stroma with scattered cells

Figure 2: Haphazardly arranged atypical cells within the stroma, some showing intracytoplasmic vacuole/lumina

Figure 3: ERG immunostain highlights those atypical cells

  Picture1 Picture2 Picture3

What is the diagnosis?

  1. Epithelioid hemangioma
  2. Epithelioid hemangioendothelioma
  3. Angiosarcoma
  4. Inflammatory pseudotumor

Case History

A 58-year-old man presented with lymphocytosis, splenomegaly, and thrombocytopenia. Based on the provided blood smear, bone marrow biopsy, and bone marrow flow cytometry, which of the following is most likely?

  1.       Hairy cell leukemia
  2.       Multiple myeloma
  3.       Acute lymphocytic leukemia
  4.       Splenic marginal zone lymphoma

 Blood FlowMarrow

Case History

The patient is a 45-year-old HIV+ male with hematemesis and weight loss. Endoscopy reveals maroon-red distal esophageal plaques and nodules.

 Microscopic examination reveals the following.

What is your diagnosis of this case?

  1.       CMV Esophagitis
  2.       Angiosarcoma
  3.       Kaposi Sarcoma + HSV Esophagitis
  4.       Kaposi Sarcoma + CMV Esophagitis

 Question Photo 1 Question Photo 2
Question Photo 3 Question Photo 4

Case History

76-year-old female with abdominal pain and rectosigmoid mass and omental nodules on CT scan. Resection of uterus, ovaries and sigmoid colon reveals 12.7 cm mass with tumor involving ovaries, uterus, and colon. Microscopic examination revealed a malignant tumor with two distinct growth patterns identified: one with solid tumor and second with glandular pattern.

Each tumor area showed different immunohistochemical result:

Solid tumor: Positive for CK7, PAX8; negative for CK20, CDX2
Glandular tumor: Positive for CK20, CDX2; negative for CK7, PAX8

Choose the correct diagnosis:

  1.       Colon adenocarcinoma with undifferentiated tumor
  2.       Carcinoma of mullerian origin with mucinous differentiation
  3.       Collision tumor of ovarian and colon origin
  4.       Mullerian adenocarcinoma, mixed epithelial type

Question Photo 1