Pathways Case Studies: July 2019

A 25-year-old man is a repeat whole blood donor and recently donated blood. Routine blood donor pathogen screening came back positive for human immunodifficiency virus-1 (HIV-1), which was confirmed by western blot and viral RNA quantitation assays. His previous donation attempt was five months ago and complicated by vasovagal reaction. That incomplete unit was discarded without testing. His previous donations were 11 months ago, 17 months ago, 22 months ago and 27 months ago were either negative or non-reactive for all required infectious disease screening tests.

	Aleh (Oleg) Bobr, M.D. Fellow, Transfusion Medicine Mayo Clinic
	Justin Kreuter, M.D. Consultant, Transfusion Medicine Mayo Clinic Instructor in Laboratory Medicine and Pathology Mayo Clinic College of Medicine @KreuterMD

A seven-year-old female presents with a left cheek mass. Flow cytometric immunophenotyping showed an abnormal cell population that expressed CD2, CD4 (partial weak), CD7, CD38, CD45 (dim), CD56, CD11c, HLA-DR, and TdT. Representative images of the biopsy are shown. Immunohistochemical stains demonstrated the infiltrate was positive for CD123, TCL1A, and TdT. CD1a, CD3, CD20, MPO, and EBER were negative.

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	Joanna Dalland, M.D. Fellow, Hematopathology Mayo Clinic
	Matthew (Matt) Howard, M.D. Consultant, Hematopathology Mayo Clinic Assistant Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

A 12-year-old male presented with a destructive mass in distal femur.

	Nooshin Karamzadeh Dashti, M.D., M.P.H. Fellow, Bone and Soft Tissue Pathology Mayo Clinic
	Carrie Inwards, M.D. Consultant, Anatomic Pathology Mayo Clinic Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

72 year old male without any significant past medical history presented with right groin soft tissue mass, measuring 12 x 9 x 7 cm. There was no connection to the underlying bone, but the mass had ruptured anteriorly into the subcutaneous compartment of the anterior thigh. The tumor cells were positive for WT1 (strong, diffuse) and CD99 (patchy), and negative for  keratin, desmin, S100,  Melan A, HMB45, PAX5, MUM1, CD43, TLE-1 and OCT4.  SMARCB1 (INI-1) is reatained. Fluorescence in situ hybridization (FISH) studies failed to show EWSR1 rearrangement, and RT-PCR did not reveal EWSR1-FLI1 or EWSR1-ERG fusion transcripts.

	Suvra Roy, M.B.B.S. Fellow, Surgical Pathology Mayo Clinic
	Karen Fritchie, M.D. Consultant, Anatomic Pathology Mayo Clinic Associate Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

A 50-year-old man who was known to have systemic hypertension developed sudden onset of severe back pain with associated diaphoresis. He lost consciousness approximately one hour after the onset of symptoms and, despite resuscitation attempts, died. An autopsy was conducted and he was found to have an acute aortic dissection originating just inferior to the left subclavian artery and extending to the iliac arteries (Stanford A/DeBakey IIIb). The following are microscopic sections of his left renal artery.

	Catherine Morris, M.D. Fellow, Cardiovascular Pathology Mayo Clinic
	Joseph Maleszewski, M.D. Professor of Laboratory Medicine and Pathology Professor of Medicine Departments of Laboratory Medicine and Pathology, Cardiovascular Medicine, and Clinical Genomics Mayo Clinic College of Medicine @joemaleszewski

An 88-year old-female presented with chronic lymphocytic leukemia under chemotherapy.

	Vijayalakshmi Nandakumar, Ph.D., M.S. Fellow, Clinical Chemistry Mayo Clinic
	Brad Karon, M.D., Ph.D. Consultant, Clinical Core Laboratory Services Mayo Clinic Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

A 60-year-old patient presented for evaluation of an asymptomatic unilateral thyroid nodule that was detected during a dental exam. A thyroidectomy was performed. Gross examination identified a firm, unifocal lesion with areas of hemorrhage and calcification.

	Krasimira (Krasi) Rozenova, M.D., Ph.D. Resident, Anatomic and Clinical Pathology Mayo Clinic
	J. Kenneth Schoolmeester, M.D. Consultant, Anatomic Pathology Mayo Clinic Assistant Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine

46 year old female presented with a renal mass. Her past medical history was significant for depression/anxiety, type 2 diabetes, hyperlipidemia, thyroid problems. CT scan demonstrated a 2.8 cm solid enhancing renal mass. The patient underwent a partial nephrectomy. Grossly, the mass measured 2.9 x 2.4 x 2 cm and was confined to the kidney.

	Malvika Solanki, M.B.B.S., Ph.D. Fellow, Multidisciplinary Breast Pathology Mayo Clinic
	John Cheville, M.D. Consultant, Anatomic and Clinical Pathology Supervisor of Rearch Services-Anatomic and Clinical Pathology, Mayo Clinic Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine