—  SPECIALTY CONFERENCE  — Surgical Pathology Tuesday, March 10, 2009, 7:30 PM Convention Center Auditorium Surgical Pathology Moderator: CHRISTOPHER D.M. FLETCHER Brigham & Women’s 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: CHRISTOPHER CRUM, Brigham & Women's Hospital, Boston, MA JESSE MCKENNEY, Stanford University Medical Center, Palo Alto, CA ANDREW CHURG, University of British Columbia, Vancouver, Canada JASON HORNICK, Brigham & Women's Hospital, Boston, MA GREGORY LAUWERS, Massachusetts General 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: Christopher Crum - Brigham & Women’s Hospital, Boston, MA Clinical Summary: A 78 year old woman with a history of invasive ductal breast carcinoma 5 years prior to presentation with metastasis to the right clavicle 2 years later . She was in good health and undergoing routine radiologic surveillance when a 3cm left adnexal mass was identified on PET /CT scan, and confirmed to be cystic on ultrasound. Left salpingo-oophorectomy was performed, with omental and retroperitoneal lymph node biopsies. Exam of the left adnexa revealed a grossly unremarkable fallopian tube and an adherent ovarian mass. The omental and lymph node biopsies were negative. The uterus and right adnexa had been removed previously, with a diagnosis of dermoid cyst. The section is from the left ovarian mass. (Case courtesy of Dr. Ciaran M. Mannion, Hackensack Medical Center, Hackensack, NJ) 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 CK7 Case 1 - Figure 7 CK20 Case 1 - Figure 8 CDX2 Case 1 - Figure 9 SMAD4 Case 1 - Figure 10 p16 Case 1 - Figure 11 p53 Case 2 Submitted by: Jesse K. McKenney - Stanford University Medical Center, Palo Alto, CA Clinical Summary: A 32 year old woman presented with abdominal pain. Imaging studies revealed lymphadenopathy in the retroperitoneum and mediastinum and a calcified renal "cyst". A core biopsy of the retroperitoneal adenopathy was performed as well as a subsequent partial nephrectomy. 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 3 Submitted by: Andrew Churg - University of British Columbia, Vancouver, Canada Clinical History: 67 year old male with a 2-3 year history of a scrotal mass, initially thought to be associated with the epididymis, but actually found at surgery to be in a hydrocoele. The hydrocoele was resected. The tumor measured approximately 2 cm across and appeared to be a solitary lesion both grossly and microscopically. 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 Pan-keratin Case 3 - Figure 9 Pan-keratin Case 3 - Figure 10 Calretinin Case 4 Submitted by: Jason L. Hornick - Brigham & Women’s Hospital, Boston, MA Clinical Summary: A 60 year-old female presented to her primary care physician complaining of a painless "bulge" in the mid abdomen. A CT scan revealed a well-circumscribed mass in the body of the pancreas, around which the pancreatic duct deviated. Endoscopic ultrasound showed a 3 cm round, hypoechoic, solid mass in the body of the pancreas at the junction with the tail, with no enlarged lymph nodes. A distal pancreatectomy was performed. 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 4 - Figure 10 Case 5 Submitted by: Gregory Y. Lauwers - Massachusetts General Hospital, Boston, MA Clinical Summary: The clinical history of this patient, a 63-year-old male, actually starts 12 months before the biopsy material available for review was sent to pathology. In the winter of 2007, this previously healthy male presented with 3 months history of rectal bleeding, abdominal cramping and weight loss. He was eventually diagnosed and operated for a 5 cm colonic adenocarcinoma (pT2N1M0). Adjuvant therapy was started using a combination of FOLFOX (5-fluorouracil, leucovorin, and oxaliplatin) and Avastin® (bevacizumab). However, 10 months post-operatively, he was diagnosed with multiple liver metastases involving both hepatic lobes for which he received FOLFIRI (5-fluorouracil, leucovorin, and irinotecan) and Avastin®. Interventional radiologic therapy was later attempted as well. Subsequently, the patient complained of belching, heartburn, and nausea. Eventually, after the symptoms waxed and waned for 2 months, an upper endoscopy was performed and demonstrated a diffusely erythematous and friable duodenal and gastric antral mucosa. Biopsies were performed. 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 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.