|
Bone & Soft Tissue Pathology
Tuesday, March 4, 2008 , 7:30 PM
Convention Center 201/203
|
Moderator:
|
BRIAN P. RUBIN
Cleveland Clinic
Cleveland, OH
|
|
Disclosure:
|
The speakers have indicated they have nothing to disclose.
|
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.
for Text and References
Submitted by: Alexander Lazar
A female age 11 presents with a 5 cm mass on her right medial knee. The lesion was present for at least 7 months and originally had the appearance of a "bruise". The parents report that the patient has experienced significantly reduced appetite and weight loss over the last several months.
Case 1 - Slide 1
|
Case 1 - Figure 1
The tumor is cystic and hemorrhagic and surrounded by a lymphoplasmacytic infiltrate and fibrosis, 20x.
|
Case 1 - Figure 2
The lymphoid infiltrate focally forms germinal centers, 100x.
|
Case 1 - Figure 3
The eosinophilic spindle cell component shows bland cytomorphology and is arranged in fascicular to slightly storiform pattern, 200x.
|
Case 1 - Figure 4
Hemorrhage is noted within the bland, eosinophilic spindle cell component, 100x.
|
Case 1 - Figure 5
Cystic areas filled with eosinophilic proteinaceous fluid are noted, 100x.
|
Case 1 - Figure 6
The lymphoplasmacytic infiltrate is intimately associated with the spindle cells, 100x.
|
Case 1 - Figure 7
Hemosiderin deposition is focally prominent, 100x.
|
for Text and References
Submitted by: Andrea Deyrup - Emory University, Atlanta, GA
The patient is a 45 year old man who presented with a 1.8 x 1.7 cm bump on his forehead, thought clinically to be a cyst. Past medical history and clinical examination were noncontributory. The lesion was biopsied and then excised. Images are from the resection specimen.
Case 2 - Slide 1
|
Case 2 - Figure 1
The tumor extends from the deep reticular dermis to subcutaneous tissue and displays a vaguely nodular architecture.
|
Case 2 - Figure 2
Higher magnification view of the tumor.
|
Case 2 - Figure 3
The nodules are composed of sheets of spindled cells aranged in short fascicles. Intratumoral and peripheral collections of lymphocytes can be appreciated.
|
Case 2 - Figure 4
The tumor cells have indistinct cell borders, lightly eosinophilic cytoplasm and vesicular nuclei with prominent nucleoli.
|
Case 2 - Figure 5
Focally, tumor cells dissect through dermal collagen forming anastamosing channels.
|
for Text and References
Submitted by: Steven Billings - Cleveland Clinic, Cleveland, OH
A 26-year-old man presented with a painful nodule on the back, clinically thought to be a cyst.
Case 3 - Slide 1
|
Case 3 - Figure 1
Scanning magnification demonstrated a myxoid tumor involving the deep dermis and subcutis.
|
Case 3 - Figure 2
The tumor was composed of randomly arranged cells embedded in a prominent myxoid stroma.
|
Case 3 - Figure 3
The tumor cells were relatively bland spindled to stellate cells with hyperchromatic nuclei.
|
Case 3 - Figure 7
The tumor infiltrated through the subcutaneous fat that in areas resulted in a honeycomb pattern.
|
Case 3 - Figure 8
Scattered multinucleated tumor cells were present.
|
Case 3 - Figure 9
There was a focal area that was more cellular. In this area the tumor cells had a storiform growth pattern.
|
for Text and References
Submitted by: Thomas Mentzel - Friedrichshafen, Germany
A 19-year-old female patient developed a dermal neoplasm on the right lateral foot. After diagnosis a wide reexcision with tumour free margins was performed, and the patient received postoperative radiotherapy (60 Gy). Two months later a solitary inguinal lymph metastasis was excised; eight other lymph nodes were tumour free. The patient received intraoperatively (10 Gy) and postoperatively (45 G) additional radiotherapy. There is no sign of recurrence at 13 months.
Case 4 - Slide 1
|
Case 4 - Figure 1
Low-power view shows an ill-defined, cellular dermal neoplasm with infiltration of superficial parts of the subcutis.
|
Case 4 - Figure 2
Plump spindled tumour cells are arranged in confluent nests and bundles. Tumour cells contain a pale eosinophilic or clear cytoplasm and enlarged nuclei.
|
Case 4 - Figure 3
Scattered multinucleated giant cells (wreath-like giant cells) are present.
|
Case 4 - Figure 4
Spindled and round tumour cell nuclei are enlarged. Note scattered mitotic figures (arrow).
|
Case 4 - Figure 5
Hyalinisation of the tumour stroma.
|
Case 4 - Figure 6
Immunohistochemically, tumour cells cells stain homogeneously positive for S-100 protein.
|
Case 4 - Figure 10
Lymph node metastasis. Most of the lymphatic tissue is replaced by confluent nests and bundles composed of atypical fusiform tumour cells.
|
Case 4 - Figure 11
Tumour cells stain positively for Melan-A.
|
for Text and References
Submitted by: Cyril Fisher - Royal Marsden Hospital, London, UK
A 19 year old female had a painless nodule on the right forearm for two years. Excision revealed an ill-defined yellow-white lesion 2 cm in diameter tethered to skin and deeper tissue.
Case 5 - Slide 1
|
Case 5 - Figure 1
The lesion is located in deep dermis and subcutis. It has a nodular or plexiform pattern.
|
Case 5 - Figure 2
Plexiform pattern with confluent and discrete tumor nodules extending into subcutaneous fat.
|
Case 5 - Figure 3
Tumor is present within dermis and incorporates adnexa.
|
Case 5 - Figure 4
At the deep aspect foci of tumor involve skeletal muscle.
|
Case 5 - Figure 5
Tumor nodules in fat show peripheral fibrosis.
|
Case 5 - Figure 6
The nodules comprise rounded mononuclear cells, bland spindle cells and an admixture of osteoclast-like giant cells, with focal fibrosis.
|
Case 5 - Figure 7
Cells in tumor nodules show no pleomorphism or mitotic activity. There is a lymphocytic infiltrate.
|
Case 5 - Figure 8
Some nodules manifest marked sclerosis or hyalinization with residual cellular component.
|
|
|
|
|
Click to view with ImageScope
Click to view with a Web-Based Viewer
