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   

Case History

A male with an age of mid 60’s underwent cholecystectomy due to cholelithiasis. The patient’s preoperative CT scan (Fig. 1) and a microscopic image of the cholecystectomy specimen (Fig. 2) are below. What is your diagnosis and next thing to do?

  1. Chronic cholecysitis with cholelithiasis. No further study is required.
  2. Hyalinizing cholecysitits. Re-examination of the specimen with additional sections is required.
  3. Gallbladder adenocarcinoma. Staging is required.
  4. Improper section- additional sections and/or recut of the block with decalcification is(are) required.

Picture1 Question Photo 2  

Case History

A 69-year-old woman presents with a thyroid mass. Representative sections of the thyroidectomy specimen are shown.

What is the most likely molecular abnormality?

  1.        BRAFV600E
  2.        BRAFK601E
  3.        RET/PTC translocation
  4.        TERT promoter mutation

HTT 10x HTT 20x HTT 40x 

Case History

45-year-old female presents with a ruptured hemorrhagic ovarian mass. The mass was received in fragments and measures 7.5 x 5.7 x 4.3 cm in aggregate. Grossly unremarkable fallopian tube is also present. IHC staining for inhibin revealed positive staining in the cells of interest & EMA was negative.

What is the diagnosis?

  1. Endometrioid adenocarcinoma, FIGO 3 
  2. High grade serous carcinoma 
  3. Low grade serous carcinoma 
  4. Granulosa cell tumor, adult type 

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

Case History

A 67-year-old man with a history of hypertension, diabetes and chronic pancreatitis presented with diarrhea and acute renal failure with serum creatinine of 5.6mg/dL (baseline 1.1mg/dL).  A renal biopsy performed showed moderate acute tubular injury (PASH Fig:1) with multiple foci of calcium oxalate crystals (H&E Fig: 2 and H&E polarized: 3). IF and EM were negative.

What is the most common cause of oxalosis?

  1.       Ethylene glycol poisoning.
  2.       Excessive ingestion of oxalate rich diet.
  3.       Enteric hyperoxaluria.
  4.       Pyridoxine deficiency.

Pic 1 Pic 2   Pic 3

Case History

Placenta at 21 weeks. Most likely diagnosis?

  1.       Choriocarcinoma
  2.       Complete Hydatidiform Mole
  3.       Partial Hydatidiform Mole
  4.       Placental Mesenchymal Dysplasia

Question Photo 1 Question Photo 2   

Question Photo 3 Question Photo 4

Case History

A 58-year-old-female with a persistent gastric ulcer presented to ER with acute abdominal pain and underwent total gastrectomy. During surgery, an enlarged lymph node was sent to frozen analysis and it was reported to be reactive. Grossly, a 2.7 x 2.5 cm perforated ulcer was noted on posterior gastric wall. The entire lesion was submitted for microscopic examination.

What is your diagnosis of this case?

  1. A. Perforated gastric adenocarcinoma
  2. B. Perforated gastric lymphoma
  3. C. Perforated stomach due to Sarcina Ventriculi
  4. D. Perforated stomach due to Staph aureus

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