Case of the Week
- Details
Case History
The patient is a 81-year-old male with a palpable breast mass. Imaging demonstrated an oval parallel mass with indistinct margins measuring 14 x 10 x 13 mm in the right breast at 1 o'clock located 1 cm from the nipple. A lumpectomy was performed and representative sections are shown.
What is the best diagnosis?
A. Metaplastic Carcinoma
B. Myofibroblastoma
C. Malignant phyllodes
D. Cellular PASH (Pseudoangiomatous stromal hyperplasia)
- Details
Case History
Neuro autopsy: 50 year old male, arrived to in asystole ER and pronounced dead after rounds of ACLS protocol. Toxicology screen negative, no medical or family history, and described by local shelter as “odd , rude, and never says anything”.
What immunohistochemical or special stain would be most useful in the diagnosis?
A. Silver stain
B. Tau
C. Alpha synuclein
D. Amyloid-B
E. PrP (prion protein)
F. IDH-1 R132H
- Details
Case History
70-year-old female, right axillary lymph node excision
What is the diagnosis?
- DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)
- AITL (Angioimmunoblastic T cell lymphoma)
- Classic Hodgkin lymphoma
- Reactive lymph node
- Details
Case History
A 34-year-old female with abdominal pain, fever, chills. CT showed uterine rupture with abscess or mass and peritonitis. Urinary hCG (-). No other past medical history. An LUS-centered transmural mass noted, with tumor cells GATA3 (+), p16 weak patchy, desmin (-); H&E shown.
What stain/s would aid in the diagnosis?
- AE1-AE3/EMA
- SMA/Ki-67
- inhibin, p63
- PAX-8/ER
- Details
Case History
A 65-year-old male presents with left axillary lymphadenopathy. Sections show a small round blue cell tumor with high N:C ratio, finely dispersed chromatin, and indistinct nucleoli with apoptotic bodies and necrotic debris. Synaptophysin and chromogranin were both diffusely positive and CD 45 negative. Provided are the H&E and CK20 IHC images.
What is the best diagnosis?
- Ewing Sarcoma
- Lymphoma
- Merkel cell carcinoma
- Details
Case History
A middle-aged male presents with a solitary thyroid mass. Fine-needle aspiration and lobectomy are performed and representative sections are shown.
What is the best diagnosis?
- Follicular adenoma with bizarre nuclei
- Poorly-differentiated thyroid carcinoma
- Medullary thyroid carcinoma
- Parathyroid adenoma
- Details
Case History
A woman was diagnosed with hyperparathyroidism. A bilateral neck exploration was performed and one gland was removed (3 cm, 2.2 g).
What is the diagnosis?
- Hypercellular parathyroid tissue consistent with hyperplasia
- Normal parathyroid tissue
- I'm not sure, check intraoperative PTH
- Details
Case History
A 58-year-old male presents with nasal obstruction. An exam shows a polypoid mass arising from the anterior nasal septum. Sections show a spindled to epithelioid neoplasm underlying nasal epithelium. Provided are the H&E and SOX10 IHC.
What genetic alteration is most commonly found in this entity at this location?
- BRAF
- NRAS
- KIT
- NF1
- BAP1
- Details
Case History
A female in her seventies presented with an 8 cm mass in the gastric body. A partial gastrectomy was performed. Representative H&E and IHC images are below.
What is the diagnosis?
- Gastric adenoma, foveolar type
- Gastric adenoma, pyloric gland type
- Gastric adenoma, intestinal type
- Gastric adenoma, oxyntic gland type
