Virtual Surgical Pathology Symposium 2021 — Case Images

Thursday, October 14

1Pulmonary PathologyA 79-year old man presented with shortness of breath and was found to have a large right pleural effusion.Image
2Pulmonary PathologyA 71-year-old male, ex-smoker, underwent coronary artery bypass grafting. He tolerated the procedure well but developed pleural effusion on day 6 post-surgery. Two days later he had worsening shortness of breath, required intubation, and went into septic shock. Image
3GI TractThe patient is an 80-year old woman with a history of dementia and a recent hip fracture who was found to have an abdominal mass. Biopsy was performed and interpreted as “Sarcoma with BCOR overexpression” based on reportedly positive BCOR immunohistochemistry (slides not available for review). The patient subsequently presented with symptoms of small bowel obstruction and underwent resection of the small bowel mass.Image
4GI TractThe patient is a 53-year old male with an endoscopically unresectable polyp in the right colon.Image
5Mysterious Melanocytic Tumors And What's Next?7-year-old male, posterior neck lesion, clinically initially suspected as a “cyst”, which grew in the past 6 months to approximately 2.0 cm, erythematous and tender. An excisional biopsy was performed.PDF
6Mysterious Melanocytic Tumors And What's Next?31-year-old female, lightly pigmented changes of periorbital skin and eyelid around the left eye with conjunctival involvement, poorly demarcated; 5 years history of slow progression including double vision and prominent eyeball, recently with significantly impaired vision and feeling of fullness.PDF
7Cytopathology Case PresentationA 37 year old woman presents with inguinal lymphadenopathy and a history of melanoma primary to the leg. Representative Pap-stained smears, H&E sections, and immunostains (SOX10 and keratin AE1/AE3 are shown).PDF
8Cytopathology Case PresentationA 52 year old woman presents with a mass in the stomach wall. The tumor cells are diffusely positive for SOX10 and S100 while keratins, CD117, and DOG1 are negative. A fluorescence in-situ hybridization study reveals an EWSR1-ATF1 translocation.PDF
9Breast Pathology Case Presentation84-year-old woman presented with a bloody nipple discharge and tenderness of the left breast. Imaging showed a 3 cm mass. She underwent an ultrasound-guided core biopsy and subsequent excision.Image
10Breast Pathology Case Presentation54-year-old female with a recurrent mass in the right breast. She had a history of fibroepithelial lesion 6 years ago, s/p excision. Now on imaging, there is a 4 cm mass close to the area of prior excision.Image 1
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Friday, October 15

Uterine Mesenchymal Tumors with Novel Genetic Alterations: An integrated approach to diagnose
60-year-old female with abnormal uterine bleeding who was found to have a myometrial-based heterogenous uterine mass by imaging.Image
Uterine Mesenchymal Tumors with Novel Genetic Alterations: An integrated approach to diagnose
40-year-old female with a history of menorrhagia and dysmenorrhea, who underwent hysterectomy for possible fibroidsImage
Genitourinary / Renal Case Study
73 year-old with elevated PSA at 8.39 ng/mLImage
Genitourinary / Renal Case Study
22 year-old with testicular mass. AFP and LDH are within normal limits. B-HCG is 27 IU/L.Image
Neurodegenerative Disease Part I

The decedent is a 60-year-old female who died with a seven-year history of cognitive impairment and motor deficits. No pertinent family history or additional history. She first presented in 2008 with sporadic jerks, REM sleep disorder, and then developed cognitive changes a few months afterwards. Physical exam showed asymmetric rigidity in arms and a slowed gait. Brain scans were performed. Eventually, she demonstrated worsening cognitive impairment. She died at home.
Neurodegenerative Disease Part II

The decedent is a 74-year-old man who died with a seven-year history of REM sleep disturbance with neurocognitive decline. Pertinent family history includes a mother and aunt who both had dementia. REM sleep disorder was first noticed in 2003 and was characterized by dream enactment and jumping out of bed with resulting injury. In 2014, he was noted to have mild motor (left greater than right upper extremity tremors) and autonomic symptoms. He also demonstrated signs of nonamnestic cognitive impairment but was overall high functioning.  Brain scans were performed. In 2018, he showed a progressive decline in ambulation, increased stiffness, weight loss, decreased speech, and urinary incontinence. He was eventually enrolled in hospice, found unresponsive in bed, and died the following day.
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A Practical Approach to Soft Tissue Lesions in Biopsy Samples
A Practical Approach to Soft Tissue Lesions in Biopsy Samples
Cytokine Release Syndrome Associated with Immune Checkpoint Inhibitor Therapy in a Patient with Metastatic Gastric Carcinoma
The patient was a 40-year-old woman who presented with abdominal pain approximately two months postpartum. An MRI of the abdomen showed numerous hepatic masses and a gastric fundus mass. A liver biopsy was obtained at an outside hospital and interpreted as a poorly-differentiated carcinoma. The patient underwent an esophagogastroduodenoscopy and a biopsy of the greater curvature of the stomach which showed a poorly differentiated carcinoma (favor adenocarcinoma) in the background of atrophic gastritis and intestinal metaplasia. After multiple rounds of chemotherapy with some response, the patient was enrolled in a clinical trial for pembrolizumab. Nine days after her fifth infusion of pembrolizumab, she presented to her local emergency room for fatigue, nausea, sore throat and shortness of breath. She was found to be septic with an acute kidney injury and dehydration. She was intubated, started on antibiotics and admitted to the ICU. She was started on continuous renal replacement therapy and administered fresh frozen plasma in the setting of disseminated intravascular coagulation. Cultures showed no growth after 5 days. The patient was eventually transitioned to comfort care and passed away.Image 1
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The Role of the Pathologist in Mass Casualty Events