Case of the Week
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Case History
84-year-old female with 1.5 cm right breast mass, s/p lumpectomy. The tumor is diffusely and strongly positive for CK7 and Cam 5.2, weakly positive for GATA3, and negative for Calponin. CK5/6, smooth muscle myosin, S100, smooth muscle actin show variable positivity. ER, PR, HER2 and AR are negative. TRSP1 is positive. Ki67 is 10%.
What is the most likely diagnosis?
B. Invasive ductal carcinoma
C. Epithelial-Myoepithelial carcinoma
D. Adenoid cystic carcinoma
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Case History
A 21-year-old pregnant female presents at term gestation in labor. She has had limited prenatal care this pregnancy. The subsequently delivered neonate shows a desquamating maculopapular rash of the soles.
Given the placental histology, which infection do you suspect?
A) Herpes Simplex Virus
B) Cytomegalovirus
C) Toxoplasma
D) Syphilis
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Case History
An elderly man presented with recurrent parotitis, a 1.8 cm enhancing nodule and innumerable enhancing <1 cm nodules in bilateral parotids. PAX-8 negative.
The most likely diagnosis is:
A. Oncocytic carcinoma
B. Metastatic renal cell carcinoma
C. Multifocal nodular oncocytic hyperplasia
D. Salivary duct carcinoma
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Case History
64-year old woman with no medical history presents with leukocytosis (Fig 1). Flow shows blasts with this phenotype: CD19+, CD10+, CD45lo, CD34+, CD20-/lo, nTdT+, cMPO-. FISH study shows 93.5% of the cells have the t(9;22)(q34;q11.2) resulting in BCR/ABL1 gene fusion.
The most likely diagnosis is:
A. Chronic Myeloid Leukemia, BCR-ABL1-positive, in blast phase
B. T-Acute lymphoblastic leukemia with t(9;22) (q34.1;q11.2); BCR-ABL1
C. B-Acute lymphoblastic leukemia with t(9;22) (q34.1;q11.2); BCR-ABL1.
D. Mixed phenotype acute leukemia with t(9;22) (q34.1;q11.2); BCR-ABL1
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Case History
65 yo male with history of bone marrow tx for multiple myeloma presents with abdominal pain and diarrhea. Colonoscopy showed inflamed mucosa with ulcerations and polypoid lesions.
The most likely diagnosis is:
A. Severely active inflammatory bowel disease
B. Malakoplakia
C. Disseminated histoplasmosis
D. Acute bacterial colitis
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Case History
The patient was a 31-year-old G1P1 mother, cesarean delivery at 32 weeks. Additional history sought after slide review.
The most likely diagnosis is:
A. Extravillous trophoblasts with benign aytpia
B. Intraplacental choriocarcinoma
C. Lymphoma
D. Metastatic adenocarcinoma
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Case History
"A middle-aged male presented with liver mass. A biopsy of the liver lesion was negative for carcinoma. Clinical impression is consistent with cholangiocarcinoma with met to "periaortic lymph node". The patient went to OR. Enlarged periaortic lymph node was sent for frozen section.
What is the best answer?
A. Ectopic liver (EC)
B. Hepatocellular carcinoma (HCC)
C. Hepatic adenoma (HA)
D. ectopic liver (EL) with HA
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Case History
A 24-year-old female with left axillary lymphadenopathy.
Which IHC marker best distinguishes the cells in Images 3 and 4?
A. CD30
B. CD15
C. CD20
D. CD3
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Case History
A 36-year-old woman with CVA a month prior is admitted to the hospital with shortness of breath. Echocardiogram reveals a 0.3 cm mitral valve mass that is successfully excised completely.
What is the diagnosis?
A. Fibroma
B. Myxoma
C. Hemangioma
D. Papillary fibroelastoma
