South East England General Histopathology EQA Scheme
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1 South East England General Round i Final Case Analyses Cases 731 to 742 Circulated September December responses (86.16%) Prepared December 2018 Authorised by: Prof J Schofield Date: 14 th December 2018 With thanks to those who contributed to this round: Trust CPA/ISO accreditation number Frimley Park Hospital NHS Foundation Trust 7496 East Sussex Healthcare NHS Trust 3077 Western Sussex Hospitals NHS Foundation Trust Surrey and Sussex Healthcare NHS Trust 1814 University Hospital Lewisham Guys and St Thomas' NHS Foundation Trust 9323 Queen Victoria Hospital NHS Foundation Trust 8238 Colchester Hospital University Foundation NHS Trust 2930 Royal Sussex County Hopsital 0779 Maidstone and Tunbridge Wells NHS Foundation Trust 8062 Kingston Hospital NHS Foundation Trust 8132 Document title: Final Case Analysis template Page 1 of 15
2 Case Number: 731 Diagnostic category: Skin : F84. 3cm lesion over right calf?scc?melanoma : Skin excision biopsy Macro : Skin ellipse 40x23x4mm with firm, slightly fleshy papular lesion, overall 30x20mm, elevated up to 7mm above the surrounding skin surface. Non-ulcerated and non-pigmented. 1 SCC (+/- Bowens / In-situ) Porocarcinoma Malignant proliferating trichilemmal tumour Pagetoid Bowen's disease 0.01 Most popular diagnosis: SCC(+/- Bowens/Insitu) Reported Diagnosis: SCC with adjacent Bowen's disease Document title: Final Case Analysis template Page 2 of 15
3 Case Number: 732 Diagnostic category: Breast : F35. Breast lump : Excision breast lump Macro : Lobulated piece of fatty tissue measuring 35x25x12 mm with a smooth external surface. Cut surface uniformly fatty. 1 Hamartoma / Adenolipoma / (fibro)lipoma Normal tissue + poss fat necrosis Fibrocystic change (+/- PASH) Fibrocystic change with fat necrosis Fat necrosis 0.08 Most popular diagnosis: Hamartoma / Adenolipoma Reported Diagnosis: Hamatoma Document title: Final Case Analysis template Page 3 of 15
4 Case Number: 733 Diagnostic category: GI : M31. Raised liver enzymes. Raised AFP. Active chronic hepatitis B. Viral load 90,000IU/ml : Liver biopsy Macro : Five cores of tissue between 5 and 12 mm 1 Chronic hepatitis (+/- fibrosis) Cirrhosis (+/- Hep B) Hepatitis with? dysplastic nodule IgG4 related cholangitis and/or autoimmune hepatitis 0.02 Most popular diagnosis: Chronic Hepatitis +/- fibrosis Reported Diagnosis: Hepatitis B Document title: Final Case Analysis template Page 4 of 15
5 Case Number: 734 Diagnostic category: Lymphoreticular : M51. Enlarged lymph node right neck (level 3 cervical lymph node) : Lymph node cervical region Macro : Fibro fatty tissue with lymph nodes measuring 55x25x17 mm. The cut surface is solid fleshy pale and tan. 1 Warthin's tumour (adenolymphoma) Metastatic papillary tumour needing IHC Lymphoepithelial lesion Metastatic carcinoma 0.03 Most popular diagnosis: Warthin s tumour (adenolymphoma) Reported Diagnosis: Warthin's tumour Document title: Final Case Analysis template Page 5 of 15
6 Case Number: 735 Diagnostic category: Endocrine : F37. Thyroid lump : Thyroid Gland Macro : Total thyroidectomy, right lobe (50x20x25mm), left lobe (40x20x20mm) and isthmus (20x25x10mm). Total weight 36g. The right lobe contains a well circumscribed nodule 20x15x35mm, containing tan and pale grey friable material. The nodule reaches up to anterior capsule. 1 Papillary carcinoma Hyperplastic nodule Thyroid Hyalinizing trabecular adenoma Follicular adenoma 0.22 Most popular diagnosis: Papillary carcinoma Reported Diagnosis: Thyroid papillary carcinoma Document title: Final Case Analysis template Page 6 of 15
7 Case Number: 736 Diagnostic category: Respiratory : F58. LLL round nodule, PET -ve, non-smoker : LLL lung wedge excision Macro : Wedge of lung 55x15x9mm, well circumscribed round nodule 18mm, 2mm from margin. 1 Pulmonary / Chondroid hamartoma 10.0 Most popular diagnosis: Pulmonary / Chondroid hamartoma Reported Diagnosis: Pulmonary hamartoma Document title: Final Case Analysis template Page 7 of 15
8 Case Number: 737 Diagnostic category: Miscellaneous : M23. Multiloculated radiolucency lower left 6 - ramus of mandible. Previous biopsy - odontogenic keratocyst. Lower left 6 with cyst lining. : Oral Macro : Cyst and associated tooth lower left mandible: Molar tooth with attached pale cyst 16x12x8mm. There is a separate grey cyst 25x18x6mm, with a mostly smooth outer surface. There are a few irregular projections over an area 10mm across. 1 Odontogenic keratocyst Odontogenic keratocyst associated with nevoid BCC Radicular cyst 0.15 Most popular diagnosis: Odontogenic keratocyst Reported Diagnosis: Keratocystic odontogenic tumour (odontogenic keratocyst) Document title: Final Case Analysis template Page 8 of 15
9 THIS CASE HAS BEEN EXCLUDED FROM PERSONAL SCORES Case Number: 738 Diagnostic category: Gynae : F33. Persistent bloody yellowish discharge. On examination large 4 x 4cm cervical mass coming from inside the canal. : Cervical Mass Macro : Multiple fragments all together 5x3x2cm in aggregate. 1 Endometriosis / Endosalpingiosis Fibroadenoma Angiomyxoma / Angiomyoblastoma Adenosarcoma Endometrial / endocervical polyp Adenofibroma Adenomyoma Adenoma Malignum (minimal deviation adenocarcinoma) Other Phyllodes tumour 0.07 Most popular diagnosis: Adenofibroma Reported Diagnosis: Adenosarcoma THIS CASE HAS BEEN EXCLUDED FROM PERSONAL SCORES Document title: Final Case Analysis template Page 9 of 15
10 Case Number: 739 Diagnostic category: GU : M23. 1cm firm lump lower part of right epididymis : Epididymal lump Macro : Pale nodule 20x10x10mm. Homogeneous pale cut surface. AE1/AE3, vimentin, calretinin, HBME-1 all positive. EMA and CD34 negative 1 Adenomatoid tumour 10.0 Most popular diagnosis: Adenometoid tumour Reported Diagnosis: Adenometoid tumour Document title: Final Case Analysis template Page 10 of 15
11 Case Number: 740 Diagnostic category: GI : F47. Abdominal pain, CT scan s/o caecal thickening. Inflamed/ulcerated caecum.?cause : Caecal biopsy Macro : Five tan biopsies largest measuring 4mm. AE, 1. PAS + ; Trichrome +; CD68-1 Amoebiasis 10.0 Most popular diagnosis: Amoebiasis Reported Diagnosis: Amoebic colitis (amebiasis) Document title: Final Case Analysis template Page 11 of 15
12 EDUCATIONAL CASE Case Number: 741 Diagnostic category: Educational : M48. Appendicitis : Appendicitis Macro : Appendix 72x9mm. The tip appears firm. Faecal contents present. CD56, CK7, Chromogranin, Synaptophysin, mutated p53 = all positive Ki67 90% Goblet cell carcinoid Well differentiated neuroendocrine carcinoma Adenocarcinoma EX goblet cell carcinoid appendix Goblet cell carcinoid tumour Adenocarcinoma ex Goblet cell carcinoid Microglandular goblet cell carcinoid Goblet cell carcinoid signet ring cell type Goblet cell carcinoid? aggressive Typical Goblet cell carcinoid Mucinous adenocarcinoma ex goblet cell carcinoid Adenocarcinoid Goblet cell adeno carcinoid Carcinoid tumour, signet ring variant, high proliferation index(grade 3) Neuroendocrine tumour/adenocarcinoid NEUROENDOCRINE CARCINOMA GRADE 3 Adenocarcinoma ex Goblet Cell Carcinoid, signet-ring type Signet ring carcinoid Goblet cell/mucnous carcinoid Signet ring cell carcinoma ex goblet cell carcinoid Adeno-carcinoid/Adenocarcinoma ex goblet cell carcinoid Goblet cell carcinoid/adenocarcinoid Goblet cell carcinoid of appendix Adenoneuroendocrine Carcinoma ADENOCARCINOMA EX-GOBLET CELL CARCINOID (SIGNET RING CELL TYPE) TYPE B Adenocarcinoma ex Goblet cell carcinoid ADENOCARCINOMA EX GOBLET CELL CARCINOID (SIGNET RING CELL TYPE) TYPE B Signet ring adenocarcinoma ex goblet cell carcinoid Goblet cell carcinoid (neuroendocrine tumour) Carcinoid Mixed adenoneuroendocrine carcinoma (MANEC) Adenocarcinoma ex GCC, signet ring type (G3) Adenocarcinoma ex-goblet cell carcinoid Mixed adenoneuroendocrine carcinoma/goblet cell adenocarcinoma Signet Ring Carcinoid Goblet cell carcinoid G3 = Goblet cell neuroendocrine carcinoma Carcinoid tumour Adenocarcinoma ex goblet cell carcinoid, signet-ring type, Tang B Schwannoma (Gastro-intestinal) Mucosal ganglioneuroma Signet ring adenoneuroendocrine carcinoma Goblet cell carcinoid tumour involving serosa Ganglioneuroma Goblet cell carcinoid (mixed adenoneuroendocrine carcinoma MANEC) G3 NET vs adenocarcinoma-ex goblet cell carcinoid Goblet cell carcinoid/ Neuroendocrine tumour Document title: Final Case Analysis template Page 12 of 15
13 Adenocarcinoid High grade neuroendocrine carcinoma Adenocarcinoma with neuroendocrine diffdrentiation Mucinous adenocarcinoma arising from goblet cell carcinoid Goblet Cell carcinoid, Grade 3 Goblet cell carcinoid, invading into the periappendiceal fat. pt3 Mixed adeno-neuroendocrine carcinoma (MANEC), subtype: goblet cell carcinoid Grade 3 Adenocarcinoma ex GCC, signet ring-type Reported Diagnosis: Adenocarcinoma-ex goblet cell carcinoid, signet ring cell type. pt4. Document title: Final Case Analysis template Page 13 of 15
14 EDUCATIONAL CASE Case Number: 742 Diagnostic category: Educational : F53. Polyp in sigmoid colon snared. : GI Macro : Brown polyp 12mm maximum diameter. S100 positive CD117, DOG1, SMA, EMA, CD34 = negative Schwannoma Polypoid Schwannoma Mucosal neuroma Neurofibroma Schwannoma of sigmoid colon Nerve sheath tumour Colonic Schwannoma. Spindle cell melanoma Schwannoma (NF/ GFAP/ EMA to exclude neurofibroma) Plexiform neurofibroma Mucosal Schwann cell hamartoma Schwannoma / Schwann cell hamartoma Neural lesion Colonic Schwannoma Ganglioneuroma. Please investigate for MEN2. Benign neural tumour Benign mucosal peripheral nerve sheath tumour GANGLIONEUROMA Intramural neurofibroma spindle cell melanoma?melan A, HMB45,? any past history MPNST GANT Submucosal spindle cell lesion with eosinophils DD Inflammatory fibroid polyp Submucosal schwann cell hamartoma/schwannoma PERIPHERAL NERVE SHEATH TUMOUR/ SCHWANOMMA Benign tumur of nerve sheath Inflammatory pseudopolyp Ganglioneuroma Colonic schwannoma Neural GIST Submucosa Schwannoma Benign neural proliferation favour neurofibroma Intestinal Schwanoma GIST Neurofibroma of the colon Neuroma (schwannian appearance) Schwannoma with ancient features Benign nerve sheath tumour Schwannoma Neural tumour-?schwannoma Benign schwannoma of colon Schwann Cell Harmatoma Inflammatory Fibroid Polyp Eosinophilic fibroid polyp Melanoma PECOMA Schwannoma of colon Ganglioneuroma?? Benign mesenchymal tumour, neurofibroma or schwannoma Benign neural tumour favouring?neurofibroma. Benign neural tumour?schwanomma Benign Schwann cell tumour/hamartoma Colonic schwannoma. Schwannoma /Mucosal Schwann cell Hamartoma Mucosal Schwann cell hamartoma/ ( previously named neurofibroma) Document title: Final Case Analysis template Page 14 of 15
15 origin(schwannmma) of sigmoid Schwann cell hamartoma submucosal schwannoma Gastrointestinal autonomic nerve tumour (GANT) Benign Nerve Sheath Tumour Plexiform neurofibroma (in neurofibromatosis) Peripheral nerve sheath tumour Inflammatory Fibroid Polyp Ganglion cell-poor ganglioneuroma Mucosal Schwann cell hamartoma Reported Diagnosis: Benign peripheral nerve sheath tumour - schwannoma (neurilemmoma). Document title: Final Case Analysis template Page 15 of 15
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