—  SPECIALTY CONFERENCE  — Pediatric Pathology Sunday, March 8, 2009, 7:30 PM Convention Center 309 Pediatric Pathology in Boston Moderator: CHERYL M. COFFIN Vanderbilt University School of Medicine, Nashville, TN 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: SARA O. VARGAS, Children's Hospital, Boston, MA PAVEL J. JEDLICKA, The Children's Hospital, Aurora, CO ROBERT B. FRASER, IWK Health Centre, Halifax, NS, Canada LOUIS P. DEHNER, Washington University Medical Center, St. Louis, MO 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: Sara O. Vargas - Children's Hospital, Boston, MA Clinical Summary: This 9-year-old boy had an incidentally discovered lung mass. He had been a healthy active child, and one day while swimming in a pool he came up for air directly in front of a chlorine jet. This caused him to cough and feel as though his throat was closing, and soon thereafter his parents brought him to his pediatrician. At this visit, the patient appeared well, and physical examination was unremarkable. A chest radiograph showed a left intrathoracic mass. A CT scan better defined the mass as a left upper lobe peripheral heterogeneous mass measuring 4.0 x 3.8 x 3.6 cm; enlarged mediastinal lymph nodes were also seen. The patient lived in a suburban Midwestern environment and had no significant travel history. His parents, a lawyer and a restauranteur, were nonsmokers. There was no family history of cancer. A needle biopsy of the pulmonary mass was interpreted as showing malignancy. A week later, the patient underwent thoracoscopic resection of the lingular mass and a mediastinal lymph node. Grossly, the lung contained a well circumscribed and slightly cystic tan mass (4.1 x 3.8 x 2 cm). The mediastinal lymph node was enlarged (3 cm). 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 2 Submitted by: Robert B. Fraser - IWK Health Centre, Halifax, NS, Canada Clinical Summary: A 6-year old boy presented with a one-week history of intermittent abdominal pain and abdominal swelling. No other constitutional symptoms. Past medical history was unremarkable and there was no significant family history or associated dysmorphic features. CT of the chest and abdomen confirms the presence of multiple pulmonary nodules and a large left-sided renal mass. He was admitted to hospital for a left nephrectomy (Case 2 - Figures 1, 2, 3). Following surgery he received chemotherapy with pulmonary and flank radiotherapy. Eighteen months off therapy, he presented with a 6-week history of a limp and an x-ray, CT and bone scan demonstrated a lytic lesion in the right proximal tibia. A bone biopsy of the leg lesion was undertaken (Case 2 - Figures 4, 5, 6). 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 3 Submitted by: Paul Jedlicka - The Children’s Hospital, Aurora, CO Clinical History: A previously healthy 2-year old female presented with a 1-month history of progressive bilateral lower extremity weakness and a neurogenic bladder. Imaging revealed an epidural tumor, which was biopsies and debulked to relieve the symptoms of spinal cord compression. Metastatic work-up was negative. She underwent chemotherapy and radiotherapy with good response and is currently in disease remission 4 years later. 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 CD99 Case 3 - Figure 6 CD99 Case 3 - Figure 7 Case 4 Submitted by: Louis P. Dehner - Washington University Medical Center, St. Louis, MO Clinical Summary: The patient is a 5-year-old female who was seen in the emergency department with a 4-5 day history of moderate to severe, cramping intermittent pain in the periumbilical region. There was regularity to the pain especially over the prior two days. She had had several bouts of vomiting over the last 24 hours. Physical examination revealed an afebrile child who did not appear to be in acute distress, was well nourished and was normally developed without any signs of endocrine dysfunction. Thoracic and abdominal scars were noted. The physical examination was otherwise unremarkable including a negative abdominal examination. A hemogram was performed with a hemoglobin of 12.1 g/dl and a white cell count of 16,500 with 85% segmented neutrophils. CT examination revealed a multicystic mass in the left kidney measuring 4.0 x 2.5 cm and a rounded soft tissue mass in the left pelvis immediately adjacent and anterior to the rectum which measured 3.4 x 3.2 cm. This mass was questioned as possibly arising in the left ovary. The pre-operative diagnosis was torsion of the left ovary. At the time of surgery, there was torsion of the left ovary with an intensely hemorrhagic appearance to the ovary as well as the presence of a 3-4 cm mass which was contiguous to the ovary. The section is from the resected left ovary which was described as weighing 48 gm and a lobulated, hemorrhagic mass measuring 8 x 4 x 2 cm. 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 4 - Figure 10 Case 4 - Figure 11 Case 4 - Figure 12 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.