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:

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.

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

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.

	Kathryn Eschbacher, M.D. Resident, Anatomic Pathology/Neuropathology Mayo Clinic
	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

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.

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

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%.

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

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).

	Fabiola Righi, D.O. Resident, Anatomic and Clinical Pathology Mayo Clinic
	Charles Sturgis, M.D. Senior Associate Consultant, Anatomic Pathology Professor of Laboratory Medicine and Pathology Mayo Clinic College of Medicine and Science