—  SPECIALTY CONFERENCE HANDOUT  — Pediatric Pathology Sunday March 21, 7:30 PM Wilson 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 Vascular Neoplasms and Malformations in Children Moderators: DAVID PARHAM University of Oklahoma Health Sciences Center College of Medicine, Oklahoma City, OK PAULA NORTH Children's Hospital of Wisconsin, Milwaukee, WI 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: PAULA E. NORTH, Children's Hospital of Wisconsin, Milwaukee, WI SARA SZABO, Children's Hospital of Wisconsin, Milwaukee, WI HARRY KOZAKEWICH, Children's Hospital Boston, Boston, MA SHARON W. WEISS, Emory University School of Medicine, Atlanta, GA 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 1A - Click here for Text and References Submitted by: Paula E. North - Children's Hospital of Wisconsin, Milwaukee, WI Clinical Summary: An 8 month old female infant presented with a bright pink, soft, 6 x 5.5 cm plaque on her upper back. In the center of the lesion there was an area of healing ulceration. At surgery, dissection was carried down to the superficial fascia, and the lesion was removed intact with minimal bleeding. Case 1a - Figure 1 Case 1a - Figure 2 Case 1a - Figure 3 Case 1a - Figure 4 Case 1a - Figure 5 Case 1a - Figure 6 Case 1a - Figure 7 Case 1a - Figure 8 Case 1a - Figure 9 Case 1B - Click here for Text and References Submitted by: Paula E. North - Children's Hospital of Wisconsin, Milwaukee, WI Clinical Summary: A 4 year old male child presented with a soft compressible nodule on the upper thigh with a reddish hue. Increased vessel prominence was noted medial to the lesion, and Dopler ultrasound indicated high flow. At surgery, a hypervascular mass restricted to the dermis and subcutis was completely excised. Case 1b - Figure 1 Case 1b - Figure 2 Case 1b - Figure 3 Case 1b - Figure 4 Case 1b - Figure 5 Case 1b - Figure 6 Case 1b - Figure 7 Case 1b - Figure 8 Case 1b - Figure 9 Case 2 - Click here for Text and References Submitted by: Sara Szabo - Children's Hospital of Wisconsin, Milwaukee, WI Clinical Summary: A newborn baby, 3150 gm, was delivered via cesarean section at 38 weeks of gestation to a 24-year old mother with lupus. A prenatal ultrasound had shown a large neck mass, which at birth was purple colored and firm. A biopsy of the mass was obtained on day of life 7. Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 CD31 Case 3A - Click here for Text and References Submitted by: Harry Kozakewich - Children's Hospital Boston, Boston, MA Clinical History: This 10 month old boy was born with a mass lateral to the left breast which was stable in size until recently it enlarged. A 6cm subcutaneous mass was excised. Case 3a - Figure 1 Case 3a - Figure 2 Case 3a - Figure 3 Case 3a - Figure 4 Case 3B - Click here for Text and References Submitted by: Harry Kozakewich - Children's Hospital Boston, Boston, MA Clinical History: This 7 year old girl had a two month history of a painful lump in her left gluteal region. The mass disappeared and then recurred. Examination revealed no cutaneous change but there was a 4cm soft, slightly tender mass in the soft tissues just behind her anterior superior iliac spine. An ultrasound showed a hypoechoic 4cm mass and a CT scan demonstrated a left gluteal muscle mass with calcifications extending into the subcutaneous fat. An excisional biopsy was done. Case 3b - Figure 1 Case 3b - Figure 2 Case 3b - Figure 3 Case 3b - Figure 4 Case 3C - Click here for Text and References Submitted by: Harry Kozakewich - Children's Hospital Boston, Boston, MA Clinical History: This 7 year old boy was born with a capillary stain on his scalp at the frontal hairline margin. Over the ensuing years, a dome-shaped mass gradually appeared. Upon examination, dilated vessels were seen at the periphery and pulsation was appreciated upon palpation. The lesion was embolized 24 hours prior to excision. Case 3c - Figure 1 Case 3c - Figure 2 Case 3c - Figure 3 Case 3c - Figure 4 Case 3c - Figure 5 Case 3c - Figure 6 Case 3c - Figure 7 Case 3c - Figure 8 Case 3c - Figure 9 Case 4 - Click here for Text and References Submitted by: Sharon W. Weiss - Emory University School of Medicine, Atlanta, GA Clinical Summary: An otherwise healthy 10 year old female was discovered to have an ill-defined mass of the thigh. At surgery an approximately 5 cm, partially cystic, white mass occupying the dermis and subcutis was removed. Case 4 - Figure 1 Low power view illustrating vascular malformation with intravascular endothelial papillations Case 4 - Figure 2 Vascular malformation showing clusters of tumor in/adjacent to wall. Case 4 - Figure 3 Clusters of tumor and lymphocytes adjacent to a lymphatic space Case 4 - Figure 4 Vascular malformation with intravascular endothelial papillations and nodules of tumor adjacent to lumen. Case 4 - Figure 5 Nodules of tumor adjacent to lymphocytes. Note vacuolization of some of the endothelial cells Case 4 - Figure 6 Intravascular endothelial papillations. Note hobnail endothelial cells covering surface of papillation and also lying free in the lumen Case 4 - Figure 7 Some of the hobnail cells show spindling and line attenuated vascular spaces reminiscent of a retiform hemangioendothelioma Case 4 - Figure 8 High power view illustrating cytologic features of hobnail endothelial cells: cuboidal shape, high nuclear cytoplasmic ratio, nuclear grooves, and cytoplasmic vacuolization. Case 4 - Figure 9 D240 immunostaining of hobnail endothelium. 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