TOTALS 30. Preliminary analysis of NNDEQA 004 (May 2013 TSL workshops) 1) 70 year old female with focal irregularity in the right breast.

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1 -- Preliminary analysis of NNDEQA 00 (May 0 TSL workshops) ) 70 year old female with focal irregularity in the right breast. Fat necrosis (with organising thrombus/foreign body granuloma/surgical site reaction) Granulomatous with vasculitis Fat necrosis (traumatic) Chronic granulomatous mastitis Duct ectasia fibrocystic change with fat necrosis 0 ) Left breast lesion in adult female CONSULTANTS Fibroadenoma (with ductal epithelial hyperplasia/complex) Fibroadenoma with atypical epithelial hyperplasia Benign Phyllodes (with epithelial hyperplasia) Benign proliferative breast lesion with usual type ductal hyperplasia and FEA Tubular carcinoma Well differrentiated invasive ductal carcinoma (tubular, sclerosing adenosis) 7 Fibroadenoma (with ductal hyperplasia/epitheliosis/fibrocystic change/cystic mastopathy) Benign phyllodes tumour Fibrocystic changes Tubular carcinoma 0 ) Right breast cyst year old female CONSULTANTS Invasive ductal carcinoma B - (high grade) DCIS (with neuroendocrine features) Papillary carcinoma Firbocystic changes with atypical or usual ductal hyperplasia Atypical ductal hyperplasia Usual duct hyperplasia Invasive ductal carcinoma Atypical ductal hyperplasia (Invasive) papillary carcinoma Sclerosing aden os is with florid ductal hyperplasia Adenomyoepithelioma 0

2 ) Left breast lesion adult female. (chronic) Granulomatous mastitis Granulomatous mastitis probably TB, exclude fungal infection Granuloma exclude sarcoid Chronic granulomatous mastitis Chronic granulomatous inflammation (most likely TB) Invasive ductal carcinoma Tuberculous mastitis (AFB positive) 9 0 ) Nipple abnormalities in a 0 year old female - nipple excised Ductal/nipple/central papilloma (and florid papillomatosis) Invasive ductal carcinoma (with pagetoid spread/background papillomatosis) Duct ectasia Lobular carcinoma Subareolar sclerosing duct hyperplasia Paget's disease of the nipple Micropapillary carcinoma ' Duct ectasia (+columnar cell metaplasia) Invasive ductal carcinoma Paget's disease Intraductal papilloma Nipple adenoma Sclerosing lymphocytic mastitis Invasive lobular carcinoma Papillary cystadenoma Neurofibroma (dermal) 0

3 ) Right breast lesion in adult female CONSULTANTS Chronic mastitis (fungal) Duct obstruction/duct ectasia/periductal mastitis (with abscess) Acute on chronic mastitis (with suppuration) Focus of malignancy surrounded by abscess Fibroadenoma with cystic mastopathy Duct ectasia/periductal mastitis Diabetic mastopathy/lymphocytic mastitis Acute on chronic mastitis Chronic granulomatous inflammation (with fat necrosis) Breast abscess Mixed invasive ductal and invasive lobular carcinoma Chronic mastitis with sclerosing aden os is Fibrocystic disease with acute on chronic mastitis 7 0 7) Right breast lump in adult female (Intermediate grade/micropapillary) DCIS Invasive ductal carcinoma Comedo carcinoma Neurofibroma Atypical ductal hyperplasia (micropapillary Papillary carcinoma DCIS (papillary/micr0p.apillary)/intraductal Micropapillary carcinoma Intracystic papillary carcinoma variant) carcinoma - 0 ) Left breast lump in adult female. (complicated) fibrocystic disease (with ductal epithelial hyperplasia/periductal inflamm) Sclerosing adenosis (with cystic mastopathy) Apocrine metaplasia Ruptured galactocoele Mucin filled ducts FEA, CCC Fibrocystic change (apocrine metaplasia/with usual duct hyperplasia) Apocrine adenosis (variant of sclerosing adenosis)/sclerosing adenosis Radial sclerosing lesion Microglandular adenosis 9 0

4 9) year old woman,? Fibroadenoma Intraduct papilloma (with epithelial hyperplasia) PASH Hormonal atrophy Blunt duct adenosis, benign Ductal hyperplasia B Sclerosing aden os is Microglandular hyperplasia Tubular adenoma Lobular hyperplasia with ductal extension Lobular neoplasia/atypical lobular hyperplasia/lobular carcinoma in-situ Invasive (tubulo) lobular carcinoma DCIS Tubular adenoma Stromal fibrosis and squamous metaplasia Intraductal papilloma, benign Flat epithelial atypia Fibrocystic disease (non-proliferative variant) PASH Sclerosing adenosis 0 0) Right breast lump in a year old woman. CONSULTANTS : Invasive lobular carcinoma (B, malignant) Invasive ductal carcinoma (B, malignant)(neuroendocrine differentiation) Intraductal carcinoma Invasive ductal carcinoma (Bb) Invasive lobular carcinoma neuroendocrine carcinoma Mixed invasive lobular and ductal carcinoma Squamous cell carcinoma, malignant 9 0

5 ) 7 year old woman with malignant calcification on x-ray/mammography. DCIS (apocrine, high grade)/intraductal carcinoma Invasive ductal carcinoma (with high grade DCIS) Medullary carcinoma Choriocarcinoma Apocrine carcinoma DCIS (high grade, apocrine, choriocarcinomatous features)/intraductal carcinoma Invasive ductal carcinoma (b, from high grade DCIS) Atypical ductal hyperplasia LCIS Mastitis Medullary carcinoma 0 ) 9 year old woman, weeks pregnant? Fibroadenoma Lactating adenoma/adenosis () - suspicious, probably benign (lactating adenosis) columnar cell change with atypia Lactating adenoma/adenosis () 7 0 ) Female 9 years, left micrododectomy/duct excision for bleeding left nipple with ulcerated surface Paget's disease with ductal carcinoma Nipple adenoma DucUintraductal papilloma Duct ectasia with epithelial hyperplasia -v, Intraductal/duct papilloma Paget's disease with ductal carcinoma Usual duct hyperplasia Periductal mastitis Nipple papillomatosis Intraductal papilloma with microinvasive ductal carcinoma 0

6 ) Right breast biopsy from? Recurrence after radiotherapy to treat previous neoplastic lesion. Female 9 years. MACROS COPY: Skin ellipse x 7 mm with underlying fibrofatty tissue x x mm. skin lesions 0 and mm in maximum dimension respectively are separated by mm of normal tissue. Angiosarcoma/lymphangiosarcoma Kaposi sarcoma Radiotherapy effect Malignant haemangiopericytoma Metaplastic carcinoma/angiosarcoma Angiosarcoma Kaposi sarcoma Low grade stromal/soft tissue sarcoma (?fibrosarcoma) Stromal sarcoma/angiosarcoma Haemangiopericytoma Metaplastic carcinoma 0 ) Left breast lump in a 7 year old female. Clinically and radiologically benign. Core biopsy - B? Phyllodes, therefore excised with cuff of normal tissue around. MACROS COPY: Tissue fragments 9 x x 9 mm and 7 g. (Giant) fibroadenoma Sclerosing adenosis Tubular adenoma Cellular fibroadenoma Benign Phyllodes tumour Sclerosing adenoma with atypia Microglandular adenosis Fibroadenoma (complex, fibroadenomatoid hyperplasia) Sclerosing adenosis Fibrocystic disease Tubular adenoma Benign Phyllodes Juvenile fibroadenoma 0

7 ) Submental lymph node from female years.? Lymphadenitis IMMUNOHISTOCHEMISTRY: Lesional cells express CD0, CD0 and Bcl-. Presence of neoplastic FDC meshwork confirmed with CD. Follicular lymphoma (no grade stated) Follicular lymphoma grade Reactive Hodgkin's lymphoma Follicular (centre cell) lymphoma (no grade stated) Angioimmunoblastic lymphadenopathy Follicular carcinoma ) Axillary lymphadenopathy year old male. IMMUNOHISTOCHEMISTRY: Tumour cells express CD0, CD and EBV-LMP but are negative with CD. Hodgkin's lymphoma (nodular sclerosis, classical, lymphocyte rich) Hodgkin's lymphoma (nodular sclerosis, classical, mixed cellularity, lymphocyte rich) Diffuse B-cell lymphoma with sclerosis 0 ) Left axillary lymph nodes biopsy in a year old female with mediastinal mass and superior vena cava obstruction.? Lymphoma IMMUNOHISTOCHEMISTRY: Not yet done Sinus hyperplasia/sinusoidal histiocytosis (+paracortical hyperplasia) Metastatic carcinoma Low grade lymphoma Reactive hyperplasia Sinus histiocytosis (reactive hyperplasia) Metastatic carcinoma Non-Hodgkin's lymphoma (low grade) Mediastinal (thymic) large B-ceillymphoma Chronic lymphadenitis 0

8 9) Enlarged lymph node from the neck of a year old female. IMMUNOHISTOCHEMISTRY: Not yet done CONSULTANTS (Reactive) follicular hyperplasia Non-Hodgkin's lymphoma (probably Burkitt) (Reactive) paracortical hyperplasia Reactive hyperplasia HIV associated lymphadenopathy (Reactive, explosive) follicular hyperplasia Diffuse B-ceillymphoma (sinusal types) 0 0 0) Left axillary lymphadenopathy in year old female. No breast mass and no skin lesions.? Lymphoma, IMMUNOHISTOCHEMISTRY: CD0 positive areas well demarcated from CDS positive areas. Follicle germinal centres negative with BcI-. CONSULTANTS Dermatopathic lymphadenopathy (reactive) Mantle cell lymphoma Reactive (?chronic lymphadenitis, sinus histiocytosis) Follicular hyperplasia Atypical hyperplasia ('(HIV) Non-Hodgkin's lymphoma Dermatopathic lymphadenopathy (reactive) Reactive (follicular and parafollicular) hyperplasia Diffuse B-cell lymphoma Mantle cell lymphoma Metastatic melanoma -, 0

9 ) Enlarged cervical lymph node in year old male.? Reactive lymphadenopathy. IMMUNOHISTOCHEMISTRY: Tumour cells express CD0 with weak expression of BcI- and very weak focal expression of MUM-. Ki-7 index is nearly 00%. There is no expression of CD 0, cyclin 0 or EBV-lMP. CD marks a very small population of reactive lymphocytes. Diffuse large B-ceillymphoma (NHl - large B-cell type) Non-Hodgkin's lymphoma Burkitt's-like lymphoma Metastatic carcinoma (from small cell carcinoma of lung) Reactive Diffuse large B-ceillymphoma T cell/histiocyte rich B cell lymphoma Non-Hodgkin's lymphoma? Necrotising inflammation Burkitt lymphoma 0 ) Right infraclavicular lymph node from a year old male. IMMUNOHISTOCHEMISTRY: lesional cells express CD0, CDS and CD Small lymphocytic Iymphoma/Cll Mantle cell lymphoma- Non-Hodgkin's lymphoma 7 Small lymphocytic Iymphoma/Cll Anaplastic lymphoma Dermatopathic lymphadenitis Small lymphocytic lymphoma (mantle) S 0

10 ) Bladder tumour resection in a 77 year old female who presented with suprapubic pain. Cystoscopy findings included grossly thickened bladder wall and cavity filled with tumour. IMMUNOHISTOCHEMISTRY: Tumour cells are negative for BcI- but express CD0 and CD0 with a Ki-7 index of 00%. CD marks a very small population of reactive lymphocytes. Burkitt's lymphoma Marginal zone (extranodal) lymphoma Metastatic carcinoma Diffuse large B-cell lymphoma Small cell carcinoma Burkitt's lymphoma metastatic transitional carcinoma Follicular B-cell lymphoma B-ceillymphoma unclassifiable 0 ) Incidental finding of enlarged right level II jugular lymph node in a 7 year old male. IMMUNOHISTOCHEMISTRY: Tumour cells are negative with CD0, but express CD0 and Bcl-. Neoplastic FDC meshwork identified with CD.. Follicular lymphoma (no grading) large B-cell lymphoma Non-Hodgkin's lymphoma B-cell type Marginal zone lymphoma Follicular lymphoma (grade ) Follular (centre cell) lymphoma (no grading) B-cell cu. (Sll) Hodgkin's lymphoma Diffuse large B-cell lymphoma Follicular (centre cell) lymphoma (grade ) Primary mediastinal large B-ceillymphoma Follicular dendritic cell sarcoma Small B-ceillymphoma (nodular variant) 0 '.

11 ) Axillary mass from a year old male. History of radiotherapy since April 0 for multiple myeloma diagnosed after spinal-cord operation. IMMUNO: tumour cells are strongly and uniformly CD0 positive with very focal strong expression of CD. They are negative for CDS, EBV-LMP, CD0, CD79a, CD, CD, CDS, CD and ALK-. Anaplastic large cell lymphoma (Alk -ve)/high grade anaplastic NHL Hodgkin's lymphoma (mixed cellularity) Multiple myeloma Amelanocytic melanoma Anaplastic large B-cell lymphoma Hodgkin's lymphoma (nodular sclerosis, classical) Anaplastic large cell lymphoma (ALK -ve) Lymphoplasmacytoma B-ceillymphoma Diffuse large B-ceillymphoma (immunoblastic) 0 List of participants AD AA adeboy ADOATBUT@0 AJD Dele Eda omo FD gbfs Ovayoza Sophie T-To xy 7day sigma AcMe ATURU GCCTHABCD GN J.C LLL olumo OVO REDHORSE stunt0

12 the don TOB UBE Young Pathologist Zinc LAGOS Akwa Ibom Anambra Bauchi Edo Enugu Kano Kwara Oyo Plateau STATES REPRESENTED II

Final analysis of NNDEQA 004 (May 2013 TSL workshops) 1) 70 year old female with focal irregularity in the right breast.

Final analysis of NNDEQA 004 (May 2013 TSL workshops) 1) 70 year old female with focal irregularity in the right breast. Final analysis of NNDEQA 00 (May 0 TSL workshops) ) 70 year old female with focal irregularity in the right breast. CONSUL TANTS Fat necrosis (with organising thrombus/foreign body granuloma/surgical site

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