2017 Annual Meeting

Evening Specialty Conference
Pulmonary Pathology

It's in the Chest, but it is not Lung

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

Moderator:
Alain Borczuk, MD
Panelists:
Cesar Moran, MD - Tamar Giorgadze, MD, PhD - Neda Kalhor, MD - Saul Suster, MD - Julia Geyer, MD

Pre-Meeting Materials

Case 1

Faculty:
Cesar Moran, MD

Clinical History:

38-year-old man presents with history of shortness of breath and chest pain. Diagnostic imaging reveals the presence of an anterior mediastinal mass. The patient does not have any previous history of malignancy. He underwent surgical resection of the tumor.

Morphological Findings (click to enlarge):

Images below represent resected mediastinal tumor.

Figure 1
Figure 2
Figure 3

Case 2

Faculty:
Tamar Giorgadze, MD, PhD

Clinical History:

A 47-year-old female (never-smoker) presented with multiple bilateral lung nodules found with a chest CT scan. CT-guided Fine Needle Aspiration and Core Biopsy of the largest 1.0 cm solid right lung nodule were performed at the outside institution. The patient was referred to the New York-Presbyterian Hospital/Weill Cornell Medicine for further evaluation. The pathology slides were reviewed at Weill Cornell Medical College Department of Pathology and Laboratory Medicine. Repeat CT chest showed 10 nodules in each lung, some of which increased in size while the others decreased in size. The previously aspirated largest right lung nodule increased in size to 1.4 cm and now was mostly cystic. The largest left lung nodule now measured 1.0 cm (previously it was 0.8 cm). The nodules that increased in size were more cystic with no definite increase in solid component.

Morphological Findings (click to enlarge):

Figure 1 FNA smear, DQ, 20x
Figure 2 FNA smear, DQ, 20x
Figure 3 FNA smear, DQ, 40x
Figure 4 FNA smear, Pap, 10x
Figure 5 FNA smear, Pap, 40x
Figure 6 FNA smear, Pap, 40x
Figure 7 ThinPrep, Pap, 60x
Figure 8 Core biopsy, H&E, 40x
Figure 9 Core biopsy, H&E, 40x
Figure 10IHC, CK7
Figure 11IHC, CK AE1/AE3
Figure 12IHC, TTF-1
Figure 13IHC, CD56
Figure 14IHC, Synaptophysin
Figure 15IHC, CD117
Figure 16IHC, LCA
Figure 17IHC, Ki67

Case 3

Faculty:
Neda Kalhor, MD

Clinical History:

38-year-old man presenting with chest pain, shortness of breath, and cough for the last two months. He underwent surgical resection of the anterior mediastinal mass.

Morphological Findings (click to enlarge):

Sections from thymectomy specimen.

Figure 1 Scanned Low Power View
Figure 2 Malt Low Power View
Figure 3 Mucosa (Lower Right) and Submucosa

Case 4

Faculty:
Saul Suster, MD

Clinical History:

A 56 year old woman was seen for shortness of breath and chest pain. CT scan showed a large anterior mediastinal mass. A core biopsy was interpreted as a poorly-differentiated carcinoma, rule out metastatic disease. Following a thorough clinical workup, no evidence of tumor could be identified elsewhere. A thoracotomy with removal of a 12.5 cm. anterior mediastinal mass was done.

Morphological Findings (click to enlarge):


Case 5

Faculty:
Julia Geyer, MD

Clinical History:

The patient is a 62 year old woman with history of follicular lymphoma, treated with 6 cycles of chemotherapy. A subsequent surveillance PET/CT identified a new 5.0 x 9.5 cm right anterior mediastinal mass. Excisional biopsy of the mediastinal mass was performed.

Morphological Findings (click to enlarge):

Figure 1 H&E 4x
Figure 2 H&E 40x
Figure 3 CK 20x
Figure 4 CD3 20x
Figure 5 Pax-5 20x
Figure 6 CD10 20x
Figure 7 TdT 20x

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