South East England General Histopathology EQA Scheme
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1 South East England General Round d Final Case Analyses Cases 671 to 682 Circulated January-February responses (87.25%) Prepared April 2017 Authorised by: Prof J Schofield Date: 18 th April 2017 With thanks to those who contributed to this round: Trust CPA/ISO accreditation number Guys and St Thomas' NHS Foundation Trust 8126 Kingston Hospital NHS Foundation Trust 8132 Surrey & Sussex Healthcare NHS Trust 1814 Frimley Park Hospital NHS Foundation Trust 7496 East Sussex Healthcare NHS Trust Queen Victoria Hospital NHS Foundation Trust 8238 Western Sussex Hospitals NHS Foundation Trust Maidstone & Tunbridge Wells NHS Trust 3060 Royal Surrey County Hospital NHS Foundation Trust 1242 Document title: Final Case Analysis template Page 1 of 13
2 Case Number: 671 Diagnostic category: Respiratory : F77. Ex-smoker. Progressive lethargy and persistent cough. Wedge resections 2 lung nodules, RML & RUL. : Respiratory Macro : Sub-pleural grey/cream nodules approx. 1.5cm. Special stains: ZN and grocott stains negative 1 Necrotising granulomatous inflammation NOS/Wegner s/tb/rheum 2 Sarcoid Lymphomatoid granulomatosis Bronchocentric granulomatosis / allergic Aspergilloma / histoplasma /?fungi Infective endocarditis Aspiration pneumonia / Infarct 0.04 Most popular diagnosis: Necrotising granulomatous inflammation. NOS/Wegners/TB/Rheum Reported Diagnosis: Wegener s granulomatosis Document title: Final Case Analysis template Page 2 of 13
3 Case Number: 672 Diagnostic category: GI : F14. RIF pain. : Appendix Macro : Pale appendix 90 x 7mm, the surface is slightly congested. 1 Enterobius Vermicularis infestation (pinworm / threadworm) Most popular diagnosis: Enterobius Vermicularis infestation (pinworm / threadworm) Reported Diagnosis: Enterobius Vermicularis parasites Document title: Final Case Analysis template Page 3 of 13
4 Case Number: 673 Diagnostic category: Miscellaneous : F28. Abdominal wall scar tissue. : Abdominal wall Macro : 50 x 40 x 25mm piece of fibrofatty tissue. Scarred and haemorrhagic on slicing. 1 Endometriosis Most popular diagnosis: Endometriosis Reported Diagnosis: Endometriosis Document title: Final Case Analysis template Page 4 of 13
5 Case Number: 674 Diagnostic category: Lymphoreticular : F45. Laparoscopic mesenteric lymph node biopsy. : Mesenteric lymph node excision Macro : Lymph node measuring 35 x 20 x 15mm with an off white homogenous cut surface. Immuno: Cells in follicles positive for CD20, CD10, BCL2, BCL6, negative for CD3, CD5,. MIB %. CD23 highlights FDC meshworks 1 Follicular NHL Most popular diagnosis: Follicular NHL Reported Diagnosis: Follicular lymphoma (G1-2) Document title: Final Case Analysis template Page 5 of 13
6 Case Number: 675 Diagnostic category: Endocrine : F55. Enlarged right thyroid lobe, right lobectomy : right thyroid lobectomy Macro : Right thyroid lobe weight 10gms measuring 45 x 32 x 16mm. 1 Papillary carcinoma / microcarcinoma Hashimoto s thyroiditis Post treated adenomatoid nodule Papillary adenoma (plus mild Hashimoto s) 0.08 Most popular diagnosis: Papillary carcinoma / microcarcinoma Reported Diagnosis: Follicular variant papillary carcinoma with lymphocytic thyroiditis in background. Document title: Final Case Analysis template Page 6 of 13
7 Case Number: 676 Diagnostic category: Gynae : F23. 23/40 IUD,?Parvovirus : Placenta Macro : This specimen comprises singleton placenta measuring 180 x 160 x 40mm bearing an eccentric umbilical cord measuring up to 240mm in length. There is a left twist to the cord and slicing reveals three vessels. The membranes show a marginal insertion and appear translucent. The maternal surface appears intact although pallor is noted. Trimmed weight 528g. 1 Parvovirus / viral infection Foetal hypoxia, hydropic degeneration Incomplete/partial mole Erythroblastosis fetalis Sickle cell disease Xanthogranuloma 0.01 Most popular diagnosis: Parvovirus / viral infection Reported Diagnosis: Parvovirus infection Document title: Final Case Analysis template Page 7 of 13
8 Case Number: 677 Diagnostic category: Skin : F14. Pigmented lesion left foot. : Skin Macro : Skin ellipse 28 x 14mm with warty plaque 14 x 10mm. 1 Spitz / Acral / pigmented naevus Malignant melanoma Atypical / dysplastic naevus 1.10 Most popular diagnosis: Spitz / Acral / pigmented naevus Reported Diagnosis: Spitz naevus Document title: Final Case Analysis template Page 8 of 13
9 Case Number: 678 Diagnostic category: GU : M35. Lump. US? malignant. Raised markers AFP 18.6 Beta HCG : Testis Macro : Testis with nodular tumour 25mm in maximum size. Pale solid and haemorrhagic cystic components. 1 Non-seminomatous / mixed germ cell tumour Most popular diagnosis: Non-seminomatous / mixed germ cell tumour Reported Diagnosis: Mixed germ cell tumour Document title: Final Case Analysis template Page 9 of 13
10 Case Number: 679 Diagnostic category: Breast : F43. Guidewire localised retro-areolar lesion. : Breast lump Macro : Fibrofatty tissue ( 3 x 2 x 1.5cm) with guidewire, marking clips and sutures. No tumour seen on the cut surface. 1 Intraductal / nipple papilloma / ductal adenoma Atypical intraductal papilloma Ectopic hidradenoma papilliferum Other DCIS 0.08 Most popular diagnosis: Intraductal / nipple papilloma / ductal adenoma Reported Diagnosis: Nipple adenoma Document title: Final Case Analysis template Page 10 of 13
11 Case Number: 680 Diagnostic category: Gynae : F51. Hysterectomy for heavy bleeding. : Uterus Macro : Uterus 90 x 50 x 50mm. A fibroid nodule is present anteriorly. Endometrial cavity is normal. Immuno: Focally D2-40, calretinin & AE1/AE3 positive. 1 Adenomatoid tumour Leiomyoma Adenomatoid tumour & endometriosis Angioleiomyoma 0.08 Most popular diagnosis: Adenomatoid tumour Reported Diagnosis: Benign adenomatoid tumour Document title: Final Case Analysis template Page 11 of 13
12 EDUCATIONAL CASE Case Number: 681 Diagnostic category: Educational : M76. (R) Upper lobectomy. : Lung Macro : Right upper lobe weighing 228g before inflation and measuring 17 x 10 x 5cm. In the centre portion of the anterior pleural surface there is a depression with 2cm diameter and a pleural adhesion. Cut section shows, underneath the pleural depression, a grey tumour with well-defined borders measuring 3.5 x 2.5 x 3.5cm. Suggested diagnoses: Adult Pulmonary Blastoma Adenosquamous carcinoma Pulmonary blastoma with florid squamous metaplasia Pulmonary Blastoma Adult Pulmonary Blastoma showing squamous morules Adenosquamous carcinoma of lung Squamous carcinoma Squamous cell carcinoma with secondary bronchiolisation of alveolar spaces Squamous cell carcinoma with bronchial metaplasia Non small cell carcinoma SCC? mets?mucoepidermoid carcinoma Lipaedic adenocarcinoma with squamous metaplasia Well differentiated fetal adenocarcinoma Peripheral type squamous cell carcinoma Well differentiated squamous cell carcinoma with entrapped bronchial structures SCC in teratoma Pulmonary Blastoma Mucoepidermoid carcinoma Mixture between a bronchoalveolar carcinoma and squamous cell carcinoma Squamous cell carcinoma with entrapped glands Unusual very mixed with squamoid, adenomatoid, areas reminiscent of mesothelial and even teratomatous origin. Could be be or unusual primary Reported Diagnosis: Invasive squamous cell carcinoma with a second component which is impossible to state definitively whether this represents a second neoplastic component (and therefore an adenosquamous carcinoma) or whether this is just a florid atypical epithelial proliferation. 2 nd opinion favoured the latter which means the possibility of an adenoquamous carcinoma cannot be excluded. Document title: Final Case Analysis template Page 12 of 13
13 EDUCATIONAL CASE Case Number: 682 Diagnostic category: Educational : F49. 7cm right breast cancer. Overseas blocks for review. Preoperative chemotherapy. Node negative. : Mastectomy Macro : Not available. 7cm tumour indicated. Immuno: Most non-acinar cells stain strongly with CK5, 34BE12, S100 and SMA. ER+ in 10% of cells. Ki67<1%. PR/HER2 negative. Neuroendocrine markers negative. Suggested diagnoses: Adenomyoepithelioma Adenomyoepithelial adenosis Epithelial Myoepithelial Carcinoma Metastatic carcinoma Adenomyoepithelioma, lobulated type Myoepithelial carcinoma Plasmacytoid breast cancer Unknown Invasive duct carcinoma, grade 2 Metastatic carcinoma with squamous metaplasia Salivary gland like tumour Adenosis tumour Adenoid cystic carcinoma Metastatic carcinoma salivary gland type Neoplasm NOS Acinar cell carcinoma Tubular adenoma Unusual lobular proliferation?lcis vs invasive lobular carcinoma Microglandular adenosis Monomorphic adenoma Malignant Leydig cell tumour Epithelioid myoepithelioma with alveolar growth pattern Basal type carcinoma Triple negative basal cell carcinoma, early relapse Acinic cell carcinoma Sectretory carcinoma Invasive apocrine carcinoma Adenosis Myoepithelioma LCIS with cancerisation of pre-existing sclerosing adenosis Post chemo changes Myoepithelial lesion Pleomorphic LCIS Florid microglandular adenosis Lobular cancerisation Atypical adenosis Reported Diagnosis: Low grade epithelial-myoepithelial carcinoma similar to those seen in salivary gland. Document title: Final Case Analysis template Page 13 of 13
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