2017 Annual Meeting

Evening Specialty Conference
Infectious Disease Pathology

Fungus in Formalin

March 8 2017, 7:30pm to 9:30pm

Moderator:
Atis Muehlenbachs, MD, PhD
Panelists:
Bobbi Pritt, MD - Alejandro Velez - Gary Procop, MD - Shawn Lockhart, PhD

Pre-Meeting Materials

Speaker 1

Faculty:
Bobbi Pritt, MD

Case 1

Clinical History:

51 year old with Stage IV refractory mantle cell lymphoma who died due to bacterial sepsis and pneumonia. On autopsy, recent multifocal hemorrhagic lesions were observed, including subarachnoid hemorrhages overlying the left inferior temporal, left parietal and occipital lobes, as well as the entire length of the spinal cord. Intraparenchymal hemorrhage with associated parenchymal necrosis was also observed involving the left basal ganglia, left parietal lobes and right occipital lobe. Images shown are from the basal ganglia.

Morphological Findings (click to enlarge):

Figure 1 Gross, dorsal aspect of the brain Image
Figure 2 Gross, ventral aspect of the brain Image
Figure 3 Gross, spinal cord
Figure 4 Gross, sagittal section showing the left basal ganglia lesion Image
Figure 5 H&E, 2x objective, basal ganglia lesion
Figure 6 H&E, 20x, basal ganglia lesion
Figure 7 H&E, 2x, meninges overlying the lesion
Figure 8 H&E, 10x, inflamed and hemorrhagic meninges Image
Figure 9 H&E, 20x, meninges and underlying parenchyma
Figure 10 GMS, 10x, meninges and underlying parenchyma
Figure 11 GMS, 40x, meninges and underlying parenchyma

Speaker 2

Faculty:
Alejandro Velez

Case 1

Clinical History:

Male 46 years old with adrenal tumor and oral ulcer

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3

Case 2

Clinical History:

Fine needle aspiration in skin lesion

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4

Speaker 3
Faculty:
Gary Procop, MD

Case 1

Clinical History:

43 year old man with changing heart murmur and fever. Vegetations were noted present on transesophageal echocardiography. The patient was taken to surgery for valve replacement surgery.

Pertinent Laboratory Data:

Leukocytosis and routine blood cultures were negative at 5 days. Cultures were performed on the excised valve for bacteria, fungi and mycobacteria.

Morphological Findings (click to enlarge):

Name the pathogen. Is this morphology typical or atypical with respect to the morphology of this organism in other anatomic locations?

Figure 1 200xhe
Figure 2 200xgms
Figure 3 400xgms
Figure 4 400xgms
Figure 5 400xgms

Case 2

Clinical History:

51 year old man with a recent history of acute leukemia. The patient was in remission following chemotherapy. A scaling lesion appeared on the patient's extremity that was thought to represent leukemia cutis. A skin biopsy was performed.

Pertinent Laboratory Data:

Leukocytosis, with no evidence of leukemia in the peripheral blood smear. Cultures for bacteria, fungi and mycobacteria were performed on the skin biopsy.

Morphological Findings (click to enlarge):

Name the pathogen. What is the taxonomic classification of this organism?

Figure 1 Clinical
Figure 2 40xhe
Figure 3 40xhe
Figure 4 200xhe
Figure 5 400xhe
Figure 6 1000xhe
Figure 7 200xgms
Figure 8 500xgms

Speaker 4

Faculty:
Shawn Lockhart, PhD

Case 1

Clinical History:

74 year old woman several week history of right arm weaknbess. Speech difficulty over last few days. Lives in Indiana, travel to florida (no travel to SW USA). Past medical history: hypertension, hyperlipidemia, asthma and GERD. Imaging: lobulated, peripheraly enhancing mass of left parieto-occipital periventricular white matter. Brain biopsy

Morphological Findings (click to enlarge):

Figure 1 H&E 40x
Figure 2 H&E 40x

Case 2

Clinical History:

53-year-old female with a history of angioimmunoblastic T-cell lymphoma who developed a liver lesion. Fine needle biopsy of the liver lesion.

Morphological Findings (click to enlarge):

Figure 3 GMS 40x
Figure 4 IHC 40x
Figure 5 PAS 40x

Meetings

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