Cytopathology

A 57-year-old woman with a history of cholecystectomy presents to the emergency room with sharp epigastric pain penetrating through to her back. She was hospitalized at that time for three days and found to have elevated pancreatic enzymes. Her imaging showed extensive pancreatic calcification, with small popcorn-type distribution throughout the gland, consistent with chronic pancreatitis. Her abdominal MRI showed innumerable pancreatic cysts throughout the pancreas, with the largest measuring at least 2.2 cm at the pancreatic head. No dilatation of the main pancreatic duct (Figure 1). The radiological differential diagnosis was multifocal branch intraductal papillary mucinous neoplasm (IPMN). The patient underwent endoscopic ultrasound fine needle aspiration (EUS/FNA) (Figure 2 A-D). Her pancreatic cyst amylase was 284110 I/U, and CEA was 145.

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Figure 2A
Figure 2B
Figure 2C
Figure 2D
Figure 3A
Figure 3B
Figure 3C
Figure 4A
Figure 4B
Figure 4C

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Photo of Sam T. Albadri, M.B., Ch.B., M.S. Sam Albadri, M.B., Ch.B., M.S.
Fellow, Cytopathology
Mayo Clinic
@Sam_Albadri
Photo of Longwen Chen, M.D., Ph.D. Longwen Chen, M.D., Ph.D.
Consultant, Anatomic Pathology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

Anatomic and Clinical Pathology—Case 1

74-year-old female presented with a painless right parotid mass that had been stable for two years. Imaging showed a (1 cm) hypoechoic, slightly lobulated nodule. The patient underwent FNA aspiration followed by resection of the right superficial parotid gland. Significant clinical history for recent squamous cell carcinoma of the right cheek and remote history of right breast invasive ductal carcinoma.

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Photo of Farah Baban, M.B., Ch.B. Farah Baban, M.B., Ch.B.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
@BabanFarah
Photo of Diva Salomao, M.D. Diva Salomao, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
@DivaRSalomao

Anatomic and Clinical Pathology—Case 2

A 21-year-old man with a history of germ cell tumor status post orchiectomy, reported as a 7 cm mass; 80% yolk sac and 20% teratomatous, presented with a lesion in his left lung. The wedge resection revealed a 1.3 cm solid mass. The tumor contained a population of mononuclear cells with nuclear pleomorphism, and a population of larger multinucleated cells with smudged chromatin. Immunohistochemistry revealed immunoreactivity to hCG and GATA3 and no immunoreactivity to OCT3/4 and CD30.

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Photo of Sara Cook, M.D., Ph.D. Sara Cook, M.D., Ph.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Photo of Ruifeng (Ray) Guo, M.D., Ph.D. Ruifeng (Ray) Guo, M.D., Ph.D.
Senior Associate Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
Photo of Loren Herrera Hernandez, M.D. Loren Herrera Hernandez, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

Anatomic and Clinical Pathology—Case 3

A 23 year old presents to his family care physician with a five-month history of right-sided facial numbness and eyelid twitching. He is a non-smoker and has no previous malignant history. An ultrasound of his face showed a 3-4 cm hypoechoic mass in the parotid. An outside biopsy was positive for a “round blue cell tumor.” Clinically the mass was rapidly enlarging over the course of weeks-months. A CT of the mass is shown.

Abrupt keratinization
CT scan
NUT necrosis

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Photo of Casey Gleue, M.D. Casey Gleue, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Image of Joaquin Garcia, M.D. Joaquín García, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

Anatomic and Clinical Pathology—Case 4

A 33-year-old previously healthy female presented with a painless abdominal lump. CT scan revealed an 8.6 cm homogeneous soft tissue mass centered in the right central mesentery with associated lymphadenopathy involving the mesenteric, retroperitoneal, and para-aortic lymph nodes. CBC showed hemoglobin of 12.6 g/dL, platelets of 304 x 10(9)/L and WBC of 7 x 10(9)/L. Core needle biopsy of the right mesenteric mass was performed. Immunohistochemical stains were negative for keratin, SOX10, CD3, CD10, CD19, CD20, CD30, ALK, BCL2, BCL6, MYC, and MUM1.

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Photo of Aishwarya Ravindran, M.B.B.S. Aishwarya Ravindran, M.B.B.S.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
@aravindranmd
Photo of Aishwarya Ravindran, M.B.B.S. Karen Rech, M.D.
Consultant, Hematopathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

Molecular Genetic Pathology

A 40-year-old female with family history of alpha-thalassemia was evaluated for anemia. The gap PCR and multiplex ligation-dependent probe amplification (MLPA) test were performed using this patient’s blood specimen. The results are shown below.

Multiplex ligation-dependent probe amplification (MLPA) results of a normal control, a heterozygous 3.7 deletion case, an anti-3.7 case, and the current case

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Photo of Guang Yang, Med., Ph.D. Guang Yang, B.Med., Ph.D.
Resident, Molecular Genetic Pathology
Mayo Clinic
Photo of Kandelaria (Ande) Rumilla, M.D. Kandelaria (Ande) Rumilla, M.D.
Consultant, Laboratory Genetics and Genomics
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine
mmledu

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