2017 Annual Meeting

Evening Specialty Conference
Bone and Soft Tissue Pathology

Diagnostic Pitfalls in Bone and Soft Tissue Pathology

March 6 2017, 7:30pm to 9:30pm

Moderator:
Jason L. Hornick, MD, PhD
Panelists:
Elizabeth Demicco, MD, PhD - Khin Thway - Francois Le Loarer, MD, PhD - Brendan Dickson, MD - Michael Klein, MD

Pre-Meeting Materials

Case 1

Faculty:
Elizabeth Demicco, MD, PhD

Clinical History:

A 51 year old man presented with a painless mass in the left calf, present for about one year. MRI showed a mass in the soleus muscle. Initial core biopsy was read as "low grade spindle cell neoplasm." A 5.7 cm tumor was resected with negative margins. Patient is without recurrence after 4 months follow-up.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6CD34
Figure 7EMA

Case 2

Faculty:
Khin Thway, MD, FRCPath

Clinical History:

25 year-old female without previous medical history, who presented when 26 weeks pregnant with pelvic pain and urinary symptoms. Imaging showed a 15 cm heterogeneous retroperitoneal/pelvic mass extending into the perineum, infiltrating the left obturator internus muscle, and adherent to part of the bladder and the uterine fundus. Grossly, the resected specimen was a 15 x 12.5 x 10 cm lobulated mass attached to the external surfaces of the uterus and bladder, but without infiltration of these organs. Sectioning showed partially necrotic tumor with a heterogeneous surface comprising firm yellowish-tan to brown solid and myxoid areas, with focal cystic degeneration.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5CDK4
Figure 6S100 Protein

Case 3

Faculty:
Francois Le Loarer, MD, PhD

Clinical History:

15 yo boy presenting with a 1cm cutaneous pimple which came up 3 months ago, located in the dorsal area. Familial history of melanoma is mentionned.

Pertinent Laboratory Data:

S100 protein is consistently expressed on immunostaining.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Case 4

Faculty:
Brendan Dickson, MD

Clinical History:

A 52 year old woman presented with recurrent haemoptysis. CT thorax revealed a left upper lobe mass. On bronchoscopy a 'fleshy' mass was identified. Brushings were called 'suspicious for malignancy', and the patient was referred for surgical resection.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7Desmin
Figure 8Keratin (AE1/AE3)
Figure 9ALK1

Case 5

Faculty:
Michael Klein, MD

Clinical History:

A 21 year old female with no pertinent previous medical history presents with pain of unknown duration and severity above her right knee. Imaging studies were performed followed by a closed biopsy of her right distal femur.

Morphological Findings (click to enlarge):

Figure 1AP Radiograph Right Knee
Figure 2Lateral Radiograph right Knee
Figure 3T1 Sagittal MRI
Figure 4T1 Axial MRI
Figure 5Fat Suppressed? Post Contrast Axial MRI

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