—  SPECIALTY CONFERENCE HANDOUT  — Bone & Soft Tissue Pathology Tuesday, March 1, 2011, 7:30 PM CC 001 A/B Clinical histories are printed below. Click on the case numbers for text and references of each case. Click on each slide thumbnail image for an enlarged view Moderator: ANDREW E. ROSENBERG Massachusetts General Hospital Boston, MA Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: SHARON WEISS, Emory University Hospital, Atlanta, GA K. KRISHNAN UNNI, WFHC – Elmbrook Memorial Hospital, Brookfield, WI G. PETUR NIELSEN, Massachusetts General Hospital, Boston, MA ALAN SCHILLER, Mt. Sinai Medical Center, New York, NY CHRISTOPHER FLETCHER, Brigham and Women’s Hospital, Boston, MA Clinical histories are displayed below. For the fastest viewing of virtual slides, click: under each thumbnail image below. You must have Aperio ImageScope installed on your PC. If you do not already have Aperio ImageScope, Windows users with administrator privileges may download and install a free version in order to view USCAP Virtual Slides. Click the icon on the right to get your free copy:   Or, click on slide thumbnail images to view each slide in a Web-based slide viewer, which is somewhat slower. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 - Click here for Text and References Submitted by: Sharon W. Weiss - Emory University Hospital, Atlanta, GA Clinical Summary: The patient was a 68 year old woman who underwent lumpectomy and radiation for breast carcinoma in 1998. In 2001, she developed multiple, small (<1 cm) flesh-pink colored papules within the area of radiation several of which were biopsied. One lesion is depicted in images 1 and 2. Another lesion is depicted in images 3 and 4. The lesions persisted and increased in number necessitating a second set of biopsies in 2003. These lesions more closely resembled those depicted in images 3 and 4. Over the next 4 years she developed approximately 60 new lesions. A third set of biopsies was performed in 2007. At this time some of the lesions appeared red and raised. Following biopsy, a wide excision of the chest wall was performed. Images 5-7 are taken from the chest wall excision. Case 1 - Figure 1 Low power view of one of the initial lesions removed in 2002 showing the classic features of AVL. Case 1 - Figure 2 High power view of image 1 showing lymphatic type spaces lined by attenuated endothelium. Case 1 - Figure 3 Low power view of another lesion removed from 2002 showing a solid appearing endothelial proliferation within the AVL. Case 1 - Figure 4 High power view of image 3 showing a solid proliferation of endothelium involving the AVL. Case 1 - Figure 5 Low power view of resection specimen from 2007 showing an angiosarcoma composed of "hobnail" endothelium. Case 1 - Figure 6 High power view of resection specimen from 2007 illustrating the features of the hobnail endothelial cells Case 1 - Figure 7 Interface of AVL and angiosarcoma. Note one of the lymphatic spaces of the AVL is colonized by cells identical to those in the angiosarcoma. Case 2 - Click here for Text and References Submitted by: K. Krishnan Unni - WFHC – Elmbrook Memorial Hospital, Brookfield, WI Clinical Summary: A 15-year-old girl presented with pain in hip of a few months duration. Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 3 - Click here for Text and References Submitted by: G. Petur Nielsen - Massachusetts General Hospital, Boston, MA Clinical Summary: A 61 year old female developed back pain radiating into the right buttock/medial thigh after a fall. The pain persisted despite physical therapy. Imaging studies showed lesions involving thoracic and lumbar vertebrae. A biopsy of one of the lesions was performed. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Low power view of the biopsy. The marrow space is replaced by the tumor. Case 3 - Figure 2 Sheets of large cells with abundant clear cytoplasm with round nuclei containing fine or homogeneously dense chromatin. There is no myxoid extracellular matrix. Case 3 - Figure 3 The tumor cells are diffusely keratin positive. Case 4 - Click here for Text and References Submitted by: Alan L. Schiller - Mt. Sinai Medical Center, New York, NY Clinical Summary: A 57 year old women with known breast carcinoma s/p lumpectomy 5.5 years complains of skull tenderness. X-ray taken. Thought to be metastatic carcinoma. Persistent tenderness over the next eight months leads to biopsy. Case 4 - Figure 1 Case 4 - Figure 2 Case 5 - Click here for Text and References Submitted by: Christopher Fletcher - Brigham and Women's Hospital, Boston, MA Clinical Summary: A 78 year old man presented with an enlarging mass in the triceps muscle. A well-circumscribed 19cm mass was excised. Case 5 - Figure 1 At low power, the lesion is well circumscribed and has a prominent myxoid matrix. Case 5 - Figure 2 Medium power demonstrates cords and strands of epithelioid cells with moderate amounts of eosinophilic cytoplasm arranged in a reticular fashion within a myxoid stroma. Case 5 - Figure 3 Closer examination demonstrates the epithelioid quality of these cells as well as irregular vesicular nuclei with focally notable nucleoli. Case 5 - Figure 4 In many areas, the tumor cells had more uniform smaller nuclei. Note the variably myxoid and hyaline stroma. Case 5 - Figure 5 Some areas of the tumor had strikingly clear cell morphology. Case 5 - Figure 6 In this field, trabeculae of eosinophilic and clear cells are admixed with one another. Case 5 - Figure 7 The tumor cells showed multifocal strong positivity for S-100 protein. Case 5 - Figure 8 There is also multifocally striking positivity for pan-keratin. Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.