|
Bone & Soft Tissue Pathology
Sunday, February 12, 2006 - 7:30 PM
International North
|
Moderator:
Brian P. Rubin
University of Washington Medical Center
Seattle, WA
Disclosure: The speakers have indicated they have nothing to disclose.
|
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:
Jason Hornick - Brigham and Women's Hospital, Boston, MA
A 42 year-old male presented with a painless mass in the left calf. MRI revealed a 9 cm nodular
enhancing mass within the soleus muscle. Following incisional biopsy, the tumor was resected.
Case 1 - Figure 1 - The tumor shows a multinodular growth pattern and variably prominent stroma.
|
Case 1 - Figure 2 - Small foci of the tumor are composed of cytologically low grade cells set in abundant chondromyxoid stroma.
|
Case 1 - Figure 3 - In other areas, cytologically atypical epithelioid cells grow in cords.
|
Case 1 - Figure 4 - Epithelioid tumor cells within a variably prominent chondroid stroma.
|
Case 1 - Figure 5 - Sheets of cytologically malignant epithelioid cells are punctuated by foci of cartilaginous differentiation.
|
Case 1 - Figure 6 - In some areas, the cartilage shows relatively bland cytomorphology.
|
Case 1 - Figure 9 - Spindle cells showing scattered pleomorphism in a hyalinized collagenous stroma.
|
Case 1 - Figure 10 - Sheets of high grade malignant epithelioid cells with abundant amphophilic cytoplasm.
|
Submitted by:
Brian P. Rubin - University of Washington Medical Center, Seattle, WA
The patient is a 51 year old man with a history of ulcerative colitis, treated with Imuran. He noted
severe right upper quadrant pain while biking, although he had experienced similar, less intense pain
for approximately 1 year. Workup revealed several liver lesions. Core needle biopsy was followed by
total liver transplantation.
Case 2 - Figure 1 - Gross specimen showing a section of liver with several circular lesions of varying sizes (arrows).
|
Case 2 - Figure 2 - There is a prominent angiocentric growth pattern with tumor cells virtually filling the lumen of a small blood vessel.
|
Case 2 - Figure 3 - Nests and cords of epithelioid cells set in a myxohyaline stroma.
|
Case 2 - Figure 4 - Occasional cells have vacuolated cytoplasm.
|
Case 2 - Figure 5 - The lesional cells are diffusely and strongly positive for CD31.
|
Case 2 - Figure 6 - The infiltrative nature of the lesion can be seen as the lesional cells are negative for cytokeratins AE1/AE3, while the entrapped hepatocytes are strongly positive.
|
Submitted by:
Matt Van De Rijn - Stanford University, Stanford, CA
A 34 year old man presented with shortness of breath. An 11 cm pleural-based mass was resected.
Submitted by:
Antonio Nascimento - Mayo Clinic, Rochester, MN
This case concerns a 60-year-old woman who was referred in June 1993 to Mayo Clinic for evaluation of
pain in her left lower extremity. The pain was present for one year but became progressively worse in
the last six months. It involved the whole left lower extremity but was particularly bad in the knee
region. Plain x-rays showed a mineralized mass in her left distal femur. The patient was taken to
the operating room on June 15, 1993 for open biopsy, frozen section diagnosis, and definitive surgical
procedure.
Case 4 - Figure 1 - X-rays of lytic lesion involving left distal femur. Note the stippled calcification that characterizes this lesion.
|
Case 4 - Figure 2 - X-rays of lytic lesion involving left distal femur. Note the stippled calcification that characterizes this lesion.
|
Case 4 - Figure 3 - Gross picture of dedifferentiated chondrosarcoma. In the medullary region, the lesion shows the classic glistening quality of well-differentiated chondroid tumor, while the extraosseous component is fleshy gray and firm.
|
Case 4 - Figure 4 - These microscopic pictures show the biphasic quality of this neoplasm.
|
Case 4 - Figure 5 - These microscopic pictures show the biphasic quality of this neoplasm.
|
Case 4 - Figure 6 - These microscopic pictures show the biphasic quality of this neoplasm.
|
Case 4 - Figure 7 - The chondroid component is highly differentiated and at most could be regarded as grade 1 chondrosarcoma.
|
Case 4 - Figure 8 - The high-grade sarcomatous component is clearly associated with formation of brightly eosinophilic, osteoid matrix, characterizing an osteosarcomatous differentiation.
|
Case 4 - Figure 9 - The high-grade sarcomatous component is clearly associated with formation of brightly eosinophilic, osteoid matrix, characterizing an osteosarcomatous differentiation.
|
Case 4 - Figure 10 - The malignant cells in the high-grade sarcomatous component have an epithelioid shape showing round to ovoid nuclei, clumped chromatin, inconspicuous nucleoli and abundant, eosinophilic cytoplasm. The osteoid is laid down directly by the tumor cells.
|
Case 4 - Figure 11 - The malignant cells in the high-grade sarcomatous component have an epithelioid shape showing round to ovoid nuclei, clumped chromatin, inconspicuous nucleoli and abundant, eosinophilic cytoplasm. The osteoid is laid down directly by the tumor cells.
|
Case 4 - Figure 12 - The malignant cells in the high-grade sarcomatous component have an epithelioid shape showing round to ovoid nuclei, clumped chromatin, inconspicuous nucleoli and abundant, eosinophilic cytoplasm. The osteoid is laid down directly by the tumor cells.
|
Submitted by:
Christopher Fletcher - Brigham & Women's Hospital, Boston, MA
A 19 year old man presented with a two-year history of a slowly enlarging lump in the arm. A 3 cm
intramuscular mass was shelled out.
Case 5 - Figure 4 - Note the typically abrupt transition between fibrous and myxoid areas.
|
Case 5 - Figure 5 - In the myxoid areas, prominent thin-walled vessels are often evident.
|
Case 5 - Figure 6 - There is no significant nuclear atypia or hyperchromasia.
|
Case 5 - Figure 7 - SMA immunostaining highlights blood vessels, but the tumor cells are negative.
|
Case 5 - Figure 8 - The tumor cells in this case are also negative for CD34, S100 protein, desmin and EMA.
|
|
|
|
|
