2017 Annual Meeting

Evening Specialty Conference
Head and Neck/Endocrine Pathology

What's New and Challenging in Head and Neck, and Endocrine Pathology?

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

Ilan Weinreb, MD
Martin Bullock, MD, FRCPC - Isabel Fonseca, MD, PhD - Michelle Williams, MD - Raja Seethala, MD

Pre-Meeting Materials

Case 1

Martin Bullock, MD, FRCPC

Clinical History:

54 year old man with 6 month history of 30 pound weight loss, hoarseness, dysphagia and several right-sided cranial neuropathies. CT showed a mass involving the right nasopharynx (crossing midline), sphenoid, and skull base with encasement of right carotid artery. Biopsy is from right nasopharynx.

Morphological Findings (click to enlarge):

Figure 1 H&E 40x
Figure 2 H&E 100x
Figure 3 H&E 100x
Figure 4 H&E 100x
Figure 5 H&E 100x
Figure 6 H&E 100x
Figure 7 H&E 400x
Figure 8 Calponin 100x
Figure 9 p16 100x
Figure 10S100 100x

Case 2

Isabel Fonseca, MD, PhD

Clinical History:

A 43 year-old man underwent a superficial parotidectomy for a slow growing mass at the right parotid gland. The tumor measured 4 cm, was multinodular, well-circumscribed, partially encapsulated, and solid with small cystic areas. Foci of necrosis were apparent.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8

Case 3

Michelle Williams, MD

Clinical History:

A 56 year old female presented with a three year history of thyroiditis and thyroid nodules. Initial fine needle aspiration (FNA) of a 1.7 cm thyroid nodule showed atypical cells of undetermined significance (ACUS). Repeat FNA at 3 months showed squamous features (Figure 1 FNA cell block). The patient proceeded to surgical resection for definitive diagnosis (Virtual slide Figure 3).

Pertinent Laboratory Data:

Immunohistochemical studies on the FNA (cell block) shows the cells with squamous features are positive for p40 (Figure 2). Immunohistochemical studies on the thyroid resection show the proliferative cells are notably positive for p40, variable weak for TTF1 and negative for PAX8, and thyroglobulin. Mucicarmine was also performed.

Morphological Findings (click to enlarge):

Figure 1 H&E cell block 10x
Figure 2 p40 cell block 20x

Case 4

Raja Seethala, MD

Clinical History:

41 year old female with a right parotid "lump" apparently present since childhood but with a recent increase in size over the past year. By clinical and radiologic examination, the lesion surrounded the facial nerve and involved the digastric and stylopharyngeus muscles. A right parotidectomy, soft tissue resection in the region of the styloid, and a selective level IIB neck dissection were performed.

Morphological Findings (click to enlarge):

Figure 1 Parotid
Figure 2 Parotid
Figure 3 Parotid
Figure 4 Parotid
Figure 5 Parotid
Figure 6 Parotid
Figure 7 Styloid
Figure 8 Styloid
Figure 9 Styloid
Figure 10Styloid
Figure 11Styloid
Figure 12Styloid


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