2017 Annual Meeting

Evening Specialty Conference
Surgical Pathology

Mimics in Surgical Pathology

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

Kumarasen Cooper, MBChB, DPhil
Bobbi Pritt, MD - Wayne Grayson, MBChB, PhD - Monalisa Sur, MBBS - John Wojcik, MD, PhD - Maria Martinez-Lage, MD

Pre-Meeting Materials

Case 1

Bobbi Pritt, MD

Clinical History:

43 year old male with tender plaques and nodules involving his left flank. The patient is from the upper Midwestern United States and has not travelled outside of the United States. His previous medical history is significant for well-controlled insulin-dependent diabetes. An excisional biopsy was performed of one of the nodules.

Morphological Findings (click to enlarge):

Images from the biopsy are shown using the 2x, 10x, and 20x objectives (H&E), demonstrating a small subcutaneous object. A Trichrome stain was also performed (taken using the 10x objective).

Figure 1 H&E - 2x
Figure 2 H&E - 10x
Figure 3 H&E - 10x
Figure 4 Trichrome - 10x
Figure 5 H&E - 20x

Case 2

Wayne Grayson, MBChB, PhD

Clinical History:

A 42-year-old man with insulin-dependent diabetes mellitus, who presented with a necrotic skin lesion on the scalp. During debridement, a suspected abscess was identified, with extension thereof into the subcutis.

Morphological Findings (click to enlarge):

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7
Figure 8
Figure 9
Figure 10

Case 3

Monalisa Sur, MBBS

Clinical History:

80 year healthy, active woman presented with post- menopausal bleeding. Endometrial Biopsy done at an outside community hospital was diagnosed as Endometrial Adenocarcinoma, cannot rule out serous carcinoma (p16 negative, p53 overexpression). She was referred to the Gyn Oncology unit at the regional cancer center. Preoperative CT scan showed a bulky uterus, thickening of right para-ovarian fossa and slightly enlarged (1.5cm) right common iliac lymph nodes. She underwent a laparoscopic hysterectomy with bilateral salpingo-oophrectomy, infracolic omentectomy, pelvic lymph node dissection and debulking of enlarged right common iliac lymph nodes. The post-operative specimen showed an enlarged uterus with tumor eroding through serosa. Grossly, there was no tumor in the cervix, tubes and ovaries and omentum. H&E section of the tumor provided. The lymph nodes showed benign reactive nodes. Staging CT scan also raised the possibility of lucency in T7 and small bilateral lung nodules of uncertain significance and possibility of metastasis was raised.

Pertinent Laboratory Data:

Blood work including CBC, electrolytes, renal function, liver panel, normal limits. Prior to her surgery her CEA was elevated which fell to 2.3 post surgery

Morphological Findings (click to enlarge):

Case 4

John Wojcik, MD, PhD

Clinical History:

A 30-year old G3P2 woman presented at 40.6 weeks with onset of labor. She had received routine prenatal care beginning at approximately 8 weeks of gestation, when she presented to the emergency department with severe abdominal cramping and was found to be pregnant. She had one additional emergency room visit for cramping in the second trimester, but an otherwise uneventful prenatal course. After failure to progress in labor, she was taken to the operating room for primary cesarean delivery of a healthy baby girl. Just prior to closure, an approximately 10 x 8 x 6 cm irregular, friable mass was seen between the rectum and the posterior uterus. At the time, it was thought to be adherent to, but not necessarily emanating from, the distal sigmoid colon. With the help of a general surgical team, this mass was removed via blunt dissection. A sample was sent for intra-operative frozen section consultation and the remainder was submitted for routine examination.

Morphological Findings (click to enlarge):

Figure 1 Lowest
Figure 2 Intermediate
Figure 3 High
Figure 4 High

Case 5

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Maria Martinez-Lage, MD
Pre-meeting materials are not available for this case


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