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Surgical Pathology
Tuesday, March 27, 2007, 7:30 PM
Convention Center 6 A/B/C/F
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Moderator:
CHRISTOPHER D.M. FLETCHER
Brigham & Women's Hospital
Boston, MA
Disclosure: The speakers have indicated they have nothing to disclose.
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for Text and References
Submitted by: Elaine S. Jaffe - National Institutes of Health, Bethesda, MD
The patient is a 45-year-old female who presented with left upper quadrant pain. CT and ultrasound showed a 5.6 cm mass within the inferior pole of the spleen. Laparoscopic splenectomy was performed.
Case 1 - Slide 1
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Case 1 - Figure 1 - At low power the spleen contains a nodule with central necrosis. While not encapsulated, the nodule is relatively sharply defined from the surrounding spleen.
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Case 1 - Figure 2 - A pseudocapsule of dense fibrosis is at the margin of the lesion.
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Case 1 - Figure 3 - A polymorphous lymphoid infiltrate surrounds an area of fibrinoid necrosis.
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Case 1 - Figure 7 - An SMA stain demonstrates increased positive spindle cells within the lesion.
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Case 1 - Figure 8 - The nuclei of the admixed spindle cells are positive with EBER in situ hybridization for EBV.
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for Text and References
Submitted by: Kumarasen Cooper - University of Vermont, Burlington, VT
An 18-year-old female presented with a history of an enlarging abdominal mass. At surgery, a large adnexal pelvic mass was resected. The contralateral ovary and uterus appeared normal.
Case 2- Slide 1
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Case 2 - Figure 1 - Tumor cells arranged in follicles, a focal feature alternating with more solid areas.
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Case 2 - Figure 2 - Follicles contain pale eosinophilic secretions.
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Case 2 - Figure 3 - Sheets of cellular tumor with mild to moderate nuclear atypia and mitotic activity (up to 2/hpf).
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for Text and References
Submitted by: Thomas M. Ulbright - Indiana University School of Medicine, Indianapolis, IN
A 6-year-old boy presented with bilateral gynecomastia. Serum estradiol was elevated (30 pg/ml). On physical examination, both testes were firm, without discrete masses. Testicular ultrasound showed multiple, small (< 3 mm) echogenic foci in both testes. Bilateral testicular biopsy was performed. The slide is from the left testicular biopsy.
Case 3 - Slide 1
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Case 3 - Figure 1 - There are lobular clusters of enlarged seminiferous tubules scattered in the testicular parenchyma.
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Case 3 - Figure 2 - In this cluster of abnormal tubules the diameters are enlarged up to 4 times those of adjacent normal tubules. The abnormal tubules contain a cellular proliferation as well as numerous round deposits of eosinophilic matrix.
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Case 3 - Figure 3 - At higher magnification it is apparent that the basement membrane around the tubules is thickened and projects into the lumen as globular extensions. The cells in the tubules represent large Sertoli cells with pale, eosinophilic cytoplasm.
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Case 3 - Figure 4 - The large intraluminal Sertoli cells have uniform, round nuclei with fine chromatin and small nucleoli. Their cytoplasm is eosinophilic and vacuolated. Mitotic figures are not seen.
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for Text and References
Submitted by: Jeffrey L. Myers - University of Michigan, Ann Arbor, MI
A 46-year-old woman was referred for evaluation of diffuse lung disease. She developed symptoms of cough in January 2006. Over the next several weeks these progressed to worsening dry cough with dyspnea. Pulmonary function tests showed mild airflow limitation, and a CT scan was described as showing mosaic attenuation. She improved within 48 hours of being started on prednisone, but her symptoms returned within 1 week of being tapered from the drug. She was a non-smoker. She started working in a new office environment that included a "large bird, something like a parakeet" around the time that her symptoms began. She had worked previously as a daycare provider. She underwent surgical lung biopsy.
Case 4 - Slide 1
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Case 4 - Figure 1 - Low magnification photomicrograph showing granulomatous inflammation exquisitely localized to small airways. Intervening lung tissue is relatively unaffected.
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Case 4 - Figure 2 - Higher magnification photomicrograph showing well formed, non-necrotizing granuloma.
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Case 4 - Figure 3 - Intermediate magnification photomicrograph showing chronic bronchiolitis with associated granuloma within the lumen of the affected airway.
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Case 4 - Figure 4 - Higher magnification view of intralumenal granuloma illustrated in Figure 3.
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Case 4 - Figure 5 - Intermediate magnification photomicrograph showing granuloma with central necrosis.
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Case 4 - Figure 6 - Higher magnification view of granuloma depicted in Figure 5 illustrating focal central necrosis.
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Case 4 - Figure 7 - Intermediate magnification photomicrograph showing chronic bronchiolitis with associated granuloma in peribronchiolar interstitium. This focus more closely resembles classical chronic hypersensitivity pneumonia.
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Case 4 - Figure 8 - Higher magnification view showing interstitial granuloma illustrated in Figure 7.
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for Text and References
Submitted by: Ralph H. Hruban - Johns Hopkins Medical Institutions, Baltimore, MD
This 60-year old man presented with the recent onset of jaundice. Abdominal imaging revealed a poorly defined mass in the head of his pancreas. A pancreatoduodenectomy was performed.
Case 5 - Slide 1
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Case 5 - Figure 4 - Progressively higher magnification views of a representative pancreatic duct
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Case 5 - Figure 5 - Intermediate and high-magnification views of the pancreatic mass
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Case 5 - Figure 6 - Intermediate and high-magnification views of the pancreatic mass
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Case 5 - Figure 7 - Intermediate and high-magnification views of blood vessels adjacent to the pancreatic mass
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Case 5 - Figure 8 - Intermediate and high-magnification views of blood vessels adjacent to the pancreatic mass
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