—  SPECIALTY CONFERENCE HANDOUT  — Bone & Soft Tissue Pathology Monday, March 9, 2009, 7:30 PM Convention Center BRA 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 Mesenchymal Tumors and Their Mimics of the Viscera Moderator: ANDREW ROSENBERG Massachusetts General Hospital Boston, MA Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: TOM COLBY, Mayo Clinic, Scottsdale, AZ ROBERT H. YOUNG, Massachusetts General Hospital, Boston, MA STUART SCHNITT, Beth Israel Deaconess Medical Center, Boston, MA JUAN ROSAI, Centro Diagnostico Italiano, Milano, Italy MAHUL AMIN, Cedars-Sinai Medical Center, Los Angeles, CA 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 - Click here for Text and References Submitted by: Robert H. Young - Massachusetts General Hospital, Harvard Medical School, Boston, MA Clinical Summary: A 61-year -old woman with abdominal pain and swelling was found to have a left adnexal mass. Laparotomy disclosed a left ovarian tumor which was removed along with the contralateral adnexa.Staging was negative. The left ovary was replaced by a 13cm in greatest dimension mass which on sectioning was composed of soft, solid tissue with abundant hemorrhage. Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1 - Figure 1 Striking spindle cell proliferation. Case 1 - Figure 2 Undulating growth of neoplastic cells, most of which have a spindle cell morphology. Case 1 - Figure 3 High-power view of prior illustrations showing focal vague tendency to form whorls. Case 1 - Figure 4 Metaplastic bone. Case 1 - Figure 5 Densely cellular aggregates of spindle cells separated by a looser myxoid component. Case 1 - Figure 6 Myxoid component. Case 1 - Figure 7 Lower-power view showing typical endometrioid glands in association with cellular foci similar to compact regions of previous illustrations. Case 1 - Figure 8 Typical endometrioid glands. Case 1 - Figure 9 Irregularly shaped epithelial formations. Case 1 - Figure 10 Spindle cells merging with foci of abortive gland differentiation. Case 1 - Figure 11 Well-delineated nests within background fibrous stroma. Case 1 - Figure 12 Low-power showing epithelial arrangements as well as spindle cell component with myxoid background. Case 2 - Click here for Text and References Submitted by: Thomas V. Colby - Mayo Clinic, Scottsdale, AZ Clinical Summary: (Case courtesty of Dr. G.H. Faber, Parkersburg, WV): A 78-year-old man with a 35 pack year smoking history was found to have a left apical lung mass on chest imaging studies. He came to lobectomy. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Necrotic cellular mass with abnormal appearing small vessels in the adjacent lung tissue Case 2 - Figure 2 Detail of the spindle cell proliferation comprising the mass Case 2 - Figure 3 Detail of the spindle cell proliferation comprising the mass Case 2 - Figure 4 Involvement of a relatively large pulmonary artery branch Case 2 - Figure 5 High power of luminal proliferation seen in Figure 4 Case 2 - Figure 6 Small vessels in the lung tissue surrounding the mass Case 2 - Figure 7 High power of the vessels shown in Figure 6 Case 2 - Figure 8 Small vessels in the lung tissue surrounding the mass Case 2 - Figure 9 High power of the vessels shown in Figure 8 Case 3 - Click here for Text and References Submitted by: Stuart J. Schnitt - Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA Clinical History: A 54 year old female presented with a 1.6 cm palpable breast mass. An excisional biopsy was performed. Case 3 - Figure 1 Low power view of the lesion showing central sclerotic zone with entrapped glands and slightly more cellular areas at the periphery. Case 3 - Figure 2 High power view of glands in the central sclerotic zone, some of which show usual ductal hyperplasia. Case 3 - Figure 3 Medium power view of the periphery of the lesion showing spindle cells in a collagenous stroma extending irregularly into surrounding adipose tissue. Case 3 - Figure 4 High power view to demonstrate the bland cytologic features of the spindle cells and low cellularity that characterized most of the lesion. Case 3 - Figure 5 High power view of the most cellular area of the lesion. A rare mitotic figure is present. Case 4 - Click here for Text and References Submitted by: Mahul B. Amin - Cedars-Sinai Medical Center, Los Angeles, CA Clinical Summary: A 41 year old male presented with a two week history of left flank pain. Abdominal CT scan revealed a solid mass lesion in the left flank measuring 12 x 10 x 8 cm. Radiographically the lesion was interpreted as renal cell carcinoma. A radical nephrectomy was performed which showed a large mass predominantly involving the perinephric soft tissue and the lower pole of the kidney (Case 4, Fig. 1). Microscopically, the tumor had an epithelioid and spindle cell morphology (Case 4, Figs. 2-9). The case was received in consultation with a differential diagnosis of sarcomatoid renal cell carcinoma versus epithelioid angiomyolipoma. Outside immunohistochemical stains showed focal positivity for HMB45 and Melan A and negativity for CK 7, CK20, and CD10. Six months later, the patient had a 6 cm in diameter local recurrence in the left renal fossa. 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 Case 4 - Figure 7 Case 4 - Figure 8 Case 4 - Figure 9 Case 5 - Click here for Text and References Submitted by: Juan Rosai - Centro Diagnostico Italiano, Milano, Italy Clinical Summary: 36-year-old male with painless mass in the right side of the neck, clinically thought to be in the thyroid gland. The patient was euthyroid and there was no cervical lymphadenopathy. There was no family history of thyroid carcinoma. A total thyroidectomy was carried out. Grossly, there was a 3,5 x 2,5 x 3 cm mass that protruded under the thin transparent capsule of the right thyroid lobe. It was solid, lobulated, well-circumscribed but not encapsulated, with a white-to-yellow cut surface. The left thyroid lobe was unremarkable. 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 Case 5 - Figure 7 Case 5 - Figure 8 Case 5 - Figure 9 If there are glass slides for a conference, they will be available for study in the microscope room in the Convention Center Room 313 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. A booklet containing an agenda for each Specialty Conference symposia and a list of speakers is provided at the meeting.