—  SPECIALTY CONFERENCE  — Surgical Pathology Monday, March 3, 2008, 7:30 PM Convention Center Korbel Ballroom Click the button above to add this event to your Itinerary Planner... Moderator: CHRISTOPHER FLETCHER Brigham & 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 Submitted by: Linda Ferrell Clinical Summary: A 37 year-old Caucasian woman was admitted with jaundice and asterixis for an expedited transplant evaluation for presumed end-stage liver disease with acute decompensation. The patient's history was remarkable for morbid obesity with a body mass index (BMI) of 59.4 three years ago. She then lost approximately 300 pounds after her Roux-en-Y gastric bypass procedure at a referring institution (no biopsy available for review) over a period of 2 years. Six months prior to this admission, she developed jaundice. She now presented with a BMI of 26.5, height 5'2", 145 pounds. Liver laboratory studies on admission at UCSF included total bilirubin of 28, AST: 105 (mildly elevated), ALT: 39 (normal), alkaline phosphatase: 124 (mildly elevated), low serum albumin, and INR of 2.4 (prolonged). Lipid studies included serum cholesterol: 74, triglycerides:102, LDL:41, HDL:13. HAV, HBV, HCV, and other viral markers (CMV, EBV, HIV) were negative; ANA, SMA, and LKM-1 antibodies were negative; ceruloplasmin and alpha-1-antitrypsin levels were within normal limits. Drug regimen had included omeprazole, spironolactone, Lasix, and lactulose. Ultrasound demonstrated hepatomegaly with fatty change, ascites, and splenomegaly. The patient had no history of diabetes, hypertension, alcohol or drug abuse. Her family history was unremarkable. Sample is from explant, performed 7 days after admission. Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer 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 1 - Figure 11 Case 1 - Figure 12 Case 2 Submitted by: David Elder Clinical Summary: Female, 33, Right posterior thigh. "Elevated, purple dome-like skin lesion". Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 Case 2 - Figure 7 Case 2 - Figure 8 Case 2 - Figure 9 - S-100 Case 2 - Figure 10 - S-100 Case 2 - Figure 11 - HMB45 Case 2 - Figure 12 - HMB45 Case 2 - Figure 13 - Actin Case 2 - Figure 14 - Actin Case 2 - Figure 15 - FVIIIRAg Case 3 Submitted by: Ian Ellis Clinical Summary: Woman aged 36, Presented with a lump in her left breast. First noticed 2 years previously. Clinically a suspicious 30mm mass. Mammography and ultrasound showed a malignant appearing 28mm speculate mass. Core biopsy showed invasive carcinoma. FNA of axillary node showed malignant cells. Right breast asymptomatic and no abnormality on clinical examination. Mammography showed 38mm of suspicious calcification. Core biopsy showed LCIS with ADH. Initial treatment left mastectomy and right wide local excision. Case material from the right breast specimen. Case 3 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 3 - Figure 1 Case 3 - Figure 2 Case 3 - Figure 3 Case 3 - Figure 4 Case 3 - Figure 5 Case 3 - Figure 6 Case 3 - Figure 7 Case 3 - Figure 8 Case 3 - Figure 9 Case 3 - Figure 10 Case 3 - Figure 11 Case 3 - Figure 12 Case 4 Submitted by: Cheryl Coffin Clinical Summary: A 13-month old boy developed a left testicular mass over a period of a few weeks. An ultrasound showed irregularity and vascularity within the mass. Serum alpha-fetoprotein and human chorionic gonadotropin levels were normal. A CT scan of the chest, abdomen, and retroperitoneum showed no evidence of malignancy. A left radical orchiectomy was performed, and subsequently the patient underwent inguinal lymph node biopsy and staging bone marrow biopsies. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 - MYOGENIN Case 4 - Figure 7 - DESMIN Case 4 - Figure 8 - SYNAPTOPHYSIN Case 5 Submitted by: Bruce Wenig Clinical Summary: A 67 year old female presented with a right neck mass. Work-up revealed a "cold" nodule in the right lobe of the thyroid gland. A fine needle aspiration biopsy was performed with a diagnosis of "atypical follicular lesion, highly suspicious for thyroid papillary carcinoma" with the recommendation for surgical resection of the thyroid lobe with intraoperative evaluation. At the time of surgery, frozen section was performed with a diagnosis of "follicular epithelial cell lesion, defer to permanent sections". A right thyroid lobectomy and isthmusectomy was performed. A well-circumscribed nodule measuring 2.1 cm in greatest dimension was identified in the right lobe of the thyroid gland. Case 5 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 5 - Figure 1 Case 5 - Figure 2 Case 5 - Figure 3 Case 5 - Figure 4 Case 5 - Figure 5 Case 5 - Figure 6 If there are glass slides for a conference, they will be available for study in the microscope room in the Convention Center Room 101 for participants who wish to review them prior to the evening session. 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. However, we will provide a booklet at the meeting which will have a page for each Specialty Conference, listing the names of speakers and space for the important "take home messages".