March 2020 — Clinical Chemistry

A 37-year-old female diagnosed with attention-deficit hyperactive disorder (ADHD) presented for her annual Adderall (amphetamine and d-amphetamine) compliance testing visit and prescription refill.

The confirmatory amphetamine urine test results were as follows:

Drug

Result

Cut-off

Amphetamine

15,988 ng/mL

< 25 ng/mL

Methamphetamine

58 ng/mL

< 25 ng/mL

Phentermine

negative

< 25 ng/mL

MDA

negative

< 25 ng/mL

MDMA

negative

< 25 ng/mL

Pseudoephedrine/ephedrine

negative

< 25 ng/mL

This patient also had a history of polysubstance abuse (methamphetamines and cocaine); however, self-reported as being in remission for a number of years. Based on the results, the provider was concerned that the patient had relapsed and started abusing methamphetamine again.

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Photo of Sarah Delaney, Ph.D. Sarah Delaney, Ph.D.
Fellow, Clinical Chemistry
Mayo Clinic
Photo of Loralie J. Langman, Ph.D. Loralie Langman, Ph.D.
Consultant, Clinical Biochemistry
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science
Image of Paul Jannetto, Ph.D. Associate Professor of Laboratory Medicine and Pathology, Division of Clinical Biochemistry, Mayo Clinic, Rochester, Minnesota Paul Jannetto, Ph.D.
Consultant, Clinical Biochemistry
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

March 2020 — Neuropathology

The patient is a 58-year-old woman with a history of atypical corticotroph pituitary adenoma, status-post two trans-sphenoidal resections and radiation. On follow-up imaging, she was found to have multiple meningeal based, extra-axial lesions, involving the right ambient cistern, left parietal, right temporal, superior parasagittal left frontal, and right superior frontal region.

T1 post-contrast highlight left parietotemporal and superior parasagittal left frontal
H&E Smear 400x
H&E 100x
H&E 400x
Chromogranin 100x
ACTH 200x
Ki67 400x

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Photo of Kathryn L. Eschbacher, M.D. Kathryn Eschbacher, M.D.
Resident, Anatomic Pathology/Neuropathology
Mayo Clinic
Photo of Rachael A. Vaubel, M.D., Ph.D. Rachael Vaubel, M.D., Ph.D
Senior Associate Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

March 2020 — Bone and Soft Tissue & Surgical

A 17 year-old male with history of DICER1 syndrome and prior resection of a benign multicystic kidney at age 2 presents with ultrasound finding of a 5.7cm echogenic mass of the left kidney. He undergoes surgical resection of the mass, which is received as three fragments of cystic, gelatinous tissue. A representative microscopic image is shown below. Immunohistochemical stains show positivity for desmin, myogenin, and Myo-D1 and negativity for cytokeratin OSCAR.

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Photo of Ryan W. Kendziora, M.D. Ryan Kendziora, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
@ryanwk14
Photo of Jorge Torres-Mora, M.D. Jorge Torres-Mora, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Assistant Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science

March 2020 — Gastroenterology

Elderly female with biopsy proven metastatic adenocarcinoma arising in the cecum. Past medical history is non-contributory. The patient underwent neoadjuvant therapy, with mixed response, prior to surgical management. Sections obtained from the right hemicolectomy specimen are shown below. Lesional cells are CDX2, synaptophysin, and chromogranin positive. Ki-67 proliferation index is >60%.

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Photo of Michael R. McCarthy, M.D. Michael McCarthy, M.D.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Photo of Christopher (Chris) Hartley, M.D. Christopher (Chris) Hartley, M.D.
Senior Associate Consultant, Anatomic Pathology
Mayo Clinic

March 2020 — Cytopathology, Pulmonary & Surgical

68-year-old female presented to the Emergency Department (ED) with complaints of progressive right-sided weakness and word finding difficulty for the previous 4 days. A computerized tomography (CT) scan was done which showed a 2.7 cm left frontal brain mass with surrounding vasogenic edema. Further workup also showed masses in the left chest wall/pleura (3.4 cm) and liver (3cm).

( Click on image to view magnified )
( Click on image to view magnified )

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Photo of 	Fabiola Righi, D.O. Fabiola Righi, D.O.
Resident, Anatomic and Clinical Pathology
Mayo Clinic
Photo of Charles D. Sturgis, M.D. Charles Sturgis, M.D.
Senior Associate Consultant, Anatomic Pathology
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine and Science
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This post was developed by our Education and Technical Publications Team.