—  SPECIALTY CONFERENCE  — Hematopathology Monday, March 9, 7:30 PM Convention Center BRB Unusual Manifestations of Well-Defined Lymphoid/Histiocytic Proliferations Moderator: MARSHA C. KINNEY University of Texas Health Science Center, San Antonio, TX 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: ELIAS CAMPO, University of Barcelona, Barcelona,Spain LETICIA M. QUINTANILLA-FEND, Eberhard Karls University of Tubingen, Tubingen, Germany RONALD JAFFE, University of Pittsburgh School of Medicine, Pittsburgh, PA ROBERT MCKENNA, University of Minnesota, Twin Cities, MN Clinical Histories and Still Images are displayed below. Click on slide thumbnail images for an enlarged view. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Ronald Jaffe - University of Pittsburgh Medical Center, Pittsburgh, PA Clinical Summary: A female patient first presented at age 42 with a 1.7cm raised, nodular, ulcerated lesion on the right knee. The pathological diagnosis was benign and no further therapy was given. A year later, biopsy of a raised 1.3cm nodule on the cheek proved to be the same process. Over the next few years, she developed additional lesions in the small and large bowel and was treated with surgery and chemotherapy. She died 8 years after first presentation with progressive tumors that involved skin, soft tissue, thyroid, lung, liver, bone and brain, including the posterior pituitary. The slide is from a liver mass at autopsy, some days after death. 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 Leukocyte Common Antigen (LCA) Case 1 - Figure 5 Vimentin Case 1 - Figure 6 CD163 Case 1 - Figure 7 S100 Case 1 - Figure 8 Ki-67 Case 2 Submitted by: Robert McKenna - University of Minnesota, Twin Cities, MN Clinical Summary: The patient is an 81 year-old female who presented with pancytopenia. Blood counts were as follows: WBC-0.8X109/L Hematocrit-27.2% MCV-92fL RDW-14.5 Platelet count-16X109/L A blood smear (images 1 and 2) and bone marrow specimen (images 3 to 5) were obtained. Immunohistochemical stains were performed on marrow particle sections (images 6 to 10). Flow cytometry was performed on the bone marrow specimen. The predominant cells showed the following immunophenotype: CD19(-), CD20(+), CD5(-), CD10(-), (s)kappa(-), (s)lambda(-) CD56(-). 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 CD138 Case 2 - Figure 7 Kappa Case 2 - Figure 8 Lambda Case 2 - Figure 9 CD20 Case 2 - Figure 10 Cyclin D1 Case 3 Submitted by: Elias Campo - University of Barcelona, Barcelona, Spain Clinical History: 78 year-old female with a 10-year history of a low grade, leukemic, B-cell neoplasm, initially diagnosed in 1995 as chronic lymphocytic leukemia [stage A(0)]. In December 2003, a stage I renal cell adenocarcinoma was resected without complication. At the end of 2004, she developed progressive lymphocytosis, anemia, and thrombocytopenia and was referred to our hospital for splenectomy. Physical examination was normal with the exception of the splenomegaly. Laboratory tests demonstrated normal LDH levels, B2 microglobulin 6.2 mg/L (normal 0-2.3) WBC 123.40 x103/µL (lymphocytes 85%), RBC 2.88 x106/µL, Hgb 8.7 g/dL, HCT 29%, MCV 89.7 fL, platelets 119 x103/µL. Flow cytometry of the peripheral blood showed a clonal lymphoid proliferation positive for CD19, CD79b, CD20 (bright), CD22, CD23 (66% of all B-lymphocytes), FMC7, IgM/IgD, kappa (bright) and negative for CD5, CD43, CD10. The general status of the patient improved after the splenectomy, but the lymphocytosis persisted. She did not receive additional treatment for two years, until July 2007, when because of progressive lymphocytosis she again received cyclophosphamide for 6 months. The patient is currently alive with clinically stable disease. 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 CD20 Case 3 - Figure 7 CD3 Case 3 - Figure 8 CD5 Case 3 - Figure 9 CD5 Case 3 - Figure 10 IgD Case 4 Submitted by: Leticia M. Quintanilla-Fend - Eberhard Karls University of Tubingen, Tubingen, Germany Clinical Summary: A 31 year-old Mexican women presented with an approximately 2 cm hyperpigmented, firm, painful lesion on the upper left thigh and inguinal lymphadenopathy on the same side. Biopsies of the skin and of one inguinal lymph node were performed. Case 4 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 4 - Slide 2 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 CD3 Case 4 - Figure 5 CD56 Case 4 - Figure 6 Granzyme B Case 4 - Figure 7 TIA-1 Case 4 - Figure 8 EBER (EBV Encoded RNA ISH) 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.