—  SPECIALTY CONFERENCE HANDOUT  — Head & Neck/Endocrine Pathology Tuesday, March 20, 2012, 7:30 PM Convention Centre 211-214 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 Diagnostically Challenging Cases Moderator: BRUCE WENIG Beth Israel Med Ctr New York, NY 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: Zubair W. Baloch, Hospital of Univ of PA, Philadelphia, PA Kenneth W. Berean, UBC Hospital, Vancouver, BC, Canada Vania Nose, University of Miami School of Medicine, Miami, FL Beverly Y. Wang, New York Univ/Medicine, New York, NY 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: Zubair W. Baloch - Hospital of Univ of PA, Philadelphia, PA Clinical Summary: A 32-year old, previously healthy woman presented with a right upper neck mass. She first noted the mass after an episode of sinusitis. Her initial visit to a local otolaryngologist was negative for dysphagia, hoarseness, neck pain, sore throat, or weight loss. The patient’s social history was significant for smoking a half a pack per day for 12 years, with cessation of cigarette smoking in 2007. During the initial physical exam, a single mass, located deep to the sternocleidomastoid and measuring approximately 2.0 x 2.0 cm, was appreciated during palpation of the right upper neck. The mass was non- tender, and no abnormalities in the overlying skin were noted. CT scan of the neck indicated the presence of an ovoid mass, measuring 1.3 x 1.0 cm, located deep to right thyroid lobe. Right paratracheal lymphadenopathy, measuring 1.5 x 1.3 cm, was also appreciated. The patient underwent ultrasound-guided FNA followed by total thyroidectomy. Pertinent Laboratory Data: Elevated serum TSH of 8.7 and decreased serum free T4 of 0.53 Case 1 - Figure 1 Case 1 - Figure 2 Case 1 - Figure 3 Case 1 - Figure 4 Case 1 - Figure 5 Case 1 - Figure 6 Case 1 - Figure 7 Case 1 - Figure 8 Case 1 - Figure 9 Case 1 - Figure 10 Case 2 - Click here for Text and References Submitted by: Kenneth W. Berean - UBC Hospital, Vancouver, BC, Canada Clinical Summary: 46 year old woman who noted a “pea-sized” lump on the left buccal mucosa. There had been some fluctuation in size over the previous few months. Examination showed no evidence of cervical lymphadenopathy. No other abnormalities were evident in the oral cavity or oropharynx. An excisional biopsy was undertaken. Case 2 - Figure 1 Tumor partially filling macrocystic space lined by one to several layers of cells Case 2 - Figure 2 Tumor composed of cells arranged in microcystic pattern with luminal amphophilic secretion Case 2 - Figure 3 Well developed microcystic architecture Case 2 - Figure 4 Tumor cells have relatively uniform ovoid nuclei and moderate amounts of eosinophilic cytoplasm Case 2 - Figure 5 Periodic acid Schiff plus diastase positive luminal secretions. Case 2 - Figure 6 Periodic acid Schiff plus diastase positive luminal secretions. Case 2 - Figure 7 Tumor cells show strong cytoplasmic and nuclear positivity with S100 protein. Case 2 - Figure 8 Tumor cells are strongly positive with cytokeratin 7. Case 2 - Figure 9 Tumor cells positive for Vimentin. Case 2 - Figure 10 Ki67 stains a low percentage of tumor cell nuclei. Case 3 - Click here for Text and References Submitted by: Vania Nose - University of Miami School of Medicine, Miami, FL Clinical Summary: 59-year-old female had upper mediastinal radiation as a child for a prominent thymus and thyroidectomy, presented with difficulty in breathing when lying down for about 4 months. Nasal cavity, nasopharynx, hypopharynx, and larynx are normal. Both vocal cords are fully mobile. There is a 3 cm mass over the anterior trachea. CT scan shows a tumor that is erosive into the left aspect of the anterior trachea below the vocal cords. There is 50% occlusion of the traches. There is no palpable adenopathy. Laryngoscopy with biopsy of the tracheal mass was performed. Case 3 - Figure 1 Thyroidectomy tumor showing an encapsulated cribriform morular variant of papillary thyroid carcinoma. Case 3 - Figure 2 Cribriform morular variant of papillary thyroid carcinoma showing both characteristic patterns: cribriform (left) and solid/spindle (right). Case 3 - Figure 3 Characteristic cribriform pattern formed by anastomozing bars that are 1-2 cell layers thick. Case 3 - Figure 4 Immunohistochemistry in these CMV of papillary thyroid carcinoma is characteristic, showing strong beta-catenin immunostaining in cytoplasm and nuclei in both morular and cribriform areas. Case 3 - Figure 5 Vocal cord with submucosal tumor infiltration showing a cribriform pattern, a constant pattern seen in CMV-PTC. Case 3 - Figure 6 Subglottis with a submucosal tumor showing the characteristic findings of CMV-PTC: presence of squamous morules with cells showing peculiar nuclear clearing and the cribriform pattern. Case 3 - Figure 7 Case 4 - Click here for Text and References Submitted by: Beverly Y. Wang - New York Univ/Medicine, New York, NY Clinical Summary: Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 PNL-2 Case 4 - Figure 7 S100 Case 4 - Figure 8 c-kit 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.