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Surgical Pathology
Tuesday, March 1, 2005 - 7:30 PM
Convention Center, Ballrooom B
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Moderator:
Elvio Silva
MD Anderson Hospital
Houston, TX
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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
Submitted by:
Anais Malpica
University of Texas
MD Anderson Cancer Center, Houston, TX
A 63 year-old female with a previous history of a total abdominal hysterectomy and bilateral
salpingoophorectomy for uterine leiomyomas presented to the emergency room with diffuse abdominal pain.
Imaging studies including CT scan of the abdomen and pelvis were normal. The patient underwent a
colonoscopic examination that was unremarkable and was given treatment for her symptoms. The abdominal
pain persisted and a second CT scan of the abdomen and pelvis performed three months later showed a 9 cm
mass in the right lower quadrant. The patient underwent exploratory laparotomy, resection of the mass,
and omentectomy.
Case 1 - Figure 1 - One of the areas of the tumor with dense cellularity (low power).
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Case 1 - Figure 2 - An area of hyalinization adjacent to an area of dense cellularity (low power).
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Case 1 - Figure 3 - A variably fascicular to storiform pattern. Note the absence of a discrete vascular pattern and the nuclear pleormorphism (intermediate power).
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Case 1 - Figure 4 - A variably fascicular to storiform pattern. Note the absence of a discrete vascular pattern and the nuclear pleormorphism (intermediate power).
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Case 1 - Figure 5 - An area of necrosis (intermediate power).
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Case 1 - Figure 6 - Nuclear pleomorphism (high power).
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Case 1 - Figure 7 - Conspicuous mitotic activity in the pleomorphic area of the tumor.
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Case 1 - Figure 8 - Conspicuous mitotic activity in the pleomorphic area of the tumor.
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Case 1 - Figure 9 - Tumor infiltrating the adipose tissue as discrete islands (low power).
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Case 1 - Figure 10 - Small and uniform cells surrounding arteriole-like vessels (same area as figure 9, intermediate power).
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Case 1 - Figure 11 - Collagen deposition (intermediate power).
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Case 1 - Figure 12 - Absence of mitotic activity, uniform cells, and arteriole-like vessels (high power).
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Submitted by:
John K.C. Chan
Queen Elizabeth Hospital
Kowloon, Hong Kong
Case identification: J136-96
A previously healthy 44-year old woman presented with low back pain. X-ray showed a calcified mass
beside the left kidney, measuring 5.5 cm. After an observation period of 6 months showing no appreciable
change in the size of the tumor, laparotomy was performed. The mass was situated in front of the upper
pole of left kidney and left adrenal gland, from which it could be separated and excized. The patient
made an uneventful recovery.
Case 2 - Figure 1 - A predominantly diffuse lesion interspersed by occasional hyaline-vascular follicles (left lower field)
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Case 2 - Figure 2 - Medium magnification reveals that the diffuse lesion comprises high endothelial venules, spindly cells and lymphocytes. In the left lower filed, there is a hyaline-vascular follicle penetrated by multiple hyalinized venules.
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Case 2 - Figure 3 - Higher magnification of hyaline-vascular follicle. The germinal center shows hyalinization and depletion of lymphoid cells. The remaining cells are follicular dendritic cells - some of which exhibit slightly enlarged and atypical nuclei.
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Case 2 - Figure 4 - Another hyaline-vascular follicle depleted of lymphoid cells. Some follicular dendritic cells exhibit markedly enlarged nuclei with irregular foldings of the nuclear membrane and coarsened chromatin ("follicular dendritic cell dysplasia").
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Case 2 - Figure 5 - Some areas of the diffuse/interfollicular zone look indistinguishable from usual hyaline-vascular Castleman disease.
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Case 2 - Figure 6 - However, some areas show in addition short fascicles of plump spindly cells in the diffuse/interfollicular zone.
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Case 2 - Figure 7 - Some plump spindly cells have markedly enlarged nuclei, vesicular chromatin and distinct nucleoli.
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Case 2 - Figure 8 - Some plump spindly cells have indistinct cell borders, large nuclei and prominent nucleoli. However, mitotic figures are very rare.
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Submitted by:
Mahul B. Amin
Emory University Hospital
Atlanta, GA
A 25-year-old female presented with dysuria and hematuria and was treated empirically with antibiotics
for urinary tract infection. Her symptoms progressively worsened, and 2 weeks later she presented again
when an ultrasound (Figure 1) showed a large intravesical mass. A transurethral resection was
performed, a diagnosis was rendered at one institution. She later had an uneventful pregnancy without
any complications. A month after the delivery, she presented to her urologist for a rapidly growing
painful mass that protruded through the urethral meatus. Submitted sections are from the large mass
(Figure 2) resected from the urethra. Representative microscopic figures (Figures 3-8).
Case received in consultation courtesy of Drs. Rafael Cabrera and Pedro Olivera, Lisbon, Portugal.
Case 3 - Figure 1 - Ultrasound showing dome-shaped intravesical mass (yellow arrows) protruding in the lumen.
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Case 3 - Figure 2 - Gross appearance of the urethral recurrence. The bivalved specimen shows a markedly hemorrhagic and fleshy cut surface.
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Case 3 - Figure 3 - Low power appearance with tumor cells arranged in nests separated by fibrovascular trabeculae of varying thickness.
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Case 3 - Figure 4 - The tumor cells have clear to focally eosinophlic cytoplasm.
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Case 3 - Figure 5 - In this high power illustration, the tumor cells show the characteristic cytologic features of both clear and granular cytoplasm. In many of the cells, the granularity is more pronounced in the center, often with a rim of clarity towards the cell membrane.
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Case 3 - Figure 6 - Nested and broad alveolar arrangement of tumor cells. The nuclei are relatively uniform, with prominent nucleoli.
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Submitted by:
Stuart J. Schnitt
Beth Israel Deaconess Medical Center
Boston, MA
A 75 year old female was found to have suspicious microcalcifiations on a screening mammogram. A
wire-localized excisional biopsy was performed.
Case 4 - Figure 1 - Pleomorphic apocrine lobular carcinoma in situ (PALCIS). Low power view demonstrating ductal spaces filled with and distended by a solid pattern proliferation of epithelial cells, with focal comedo necrosis and calcifications.
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Case 4 - Figure 2 - Pleomorphic apocrine lobular carcinoma in situ (PALCIS). Medium power view showing comedo necrosis and calcification in one of the involved spaces.
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Case 4 - Figure 3 - Pleomorphic apocrine lobular carcinoma in situ (PALCIS). At higher power, the abundant eosinophilic cytoplasm of the neoplastic cells is evident as is the cellular dyshesion.
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Case 4 - Figure 4 - Pleomorphic apocrine lobular carcinoma in situ (PALCIS). Nuclear pleomorphism and "apocrine" cytoplasmic features are evident in this high power view.
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Submitted by:
Virginia A. Livolsi
University of Pennsylvania Medical Center
Philadelphia, PA
This 44 year old man presented with a 6 cm mass in his right thyroid. FNA attempted twice, yielded
insufficient material for diagnosis.
His family history was negative for thyroid disease or for cancer; he had no history of radiation
exposure.
Case 5 - Figure 1 - (Labeled USCAP 2005 Silva x 10): Medium power view of the central part of the thyroid nodule which comprised about 90% of the 6 cm lesion (H&E stain).
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Case 5 - Figure 2 - (Labeled VAL 04-1272-thyroid…): Spindle cell proliferation admixed with bland appearing colloid filled follicles. (H&E stain)
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Case 5 - Figure 3 - (Labeled USCAP case 2005 X 20): High power shows focall nuclear enlargment and irregularity, but no mitoses or necrosis were identified. (H&E stain)
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