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)


  Huang_Case_1_2022.jpg Huang Case 2 2022

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


 Maveal_Case_4_2022.jpg Maveal_Case_1_2022.jpg

Case History

70-year-old female, right axillary lymph node excision

What is the diagnosis?

  1.        DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms)
  2.        AITL (Angioimmunoblastic T cell lymphoma)
  3.        Classic Hodgkin lymphoma
  4. Reactive lymph node

Pickens_Case_1_2022.png Pickens_Case_2_2022.png

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?

  1.        AE1-AE3/EMA
  2.        SMA/Ki-67
  3.        inhibin, p63
  4. PAX-8/ER

   Kahn_Case_1_2022.jpg Kahn_Case_2_2022.jpg

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?

  1.        Ewing Sarcoma
  2.        Lymphoma
  3.        Merkel cell carcinoma

  Ahmed_Case_1_2022.png Ahmed_Case_2_2022.png

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?

  1.        Follicular adenoma with bizarre nuclei
  2.        Poorly-differentiated thyroid carcinoma
  3.        Medullary thyroid carcinoma
  4. Parathyroid adenoma

FA_bizarre_nuclei_10x.jpg  FA_bizarre_nuclei_DQ_20x.jpg

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?

  1.        Hypercellular parathyroid tissue consistent with hyperplasia
  2.        Normal parathyroid tissue
  3.        I'm not sure, check intraoperative PTH

    Lora_Gonzalez_Case_1_2022.jpg Lora_Gonzalez_Case_2_2022.jpg

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?

  1.        BRAF
  2.        NRAS
  3.        KIT
  4. NF1
  5. BAP1

Prater Case 2022 1 Prater Case 2022 2   

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?

  1.        Gastric adenoma, foveolar type
  2.        Gastric adenoma, pyloric gland type
  3.        Gastric adenoma, intestinal type
  4. Gastric adenoma, oxyntic gland type

Goo_Lee_Case_1_2022.jpg   Goo_Lee_Case_2_2022.jpg