23rd International Surgical Pathology Symposium – Case Images

Tuesday, May 2

1GI30-year-old woman with a large pancreatic mass found after experiencing abdominal painH&E
2GI50-year-old man with a 3.0cm liver massA1 H&E 1
A1 H&E 2
A2 H&E 1
A2 H&E 2
3GI67-year-old man with a 6.4cm esophageal mass found after dysphagiaH&E
CK 8/18
4Cytology76 year old man with a history of multiple myeloma and prostate cancer, presenting with enlarged mediastinal lymph nodes concerning for metastatic disease. image
5Cytology57-year-old female with a 30 pack year smoking history, presenting with cough, shortness of breath, and a left hilar mass on imaging. image
6Cytology76 year old male former smoker with chronic obstructive pulmonary disease, presenting with shortness of breath and a right sided pleural effusion. image
7HemepathA 65-year-old male presents with 20lb weight loss, malaise, and is found to have inguinal and axillary lymphadenopathy. Excisional biopsy of an inguinal lymph node is shown.  image
8HemepathA 47-year-old woman presents with “lumps” in her neck and is found to have diffuse lymphadenopathy. Excisional biopsy of a cervical lymph node is shown.  image 
9HemepathA 23-year-old woman status post renal transplant 1 year ago for lupus nephritis presents with fevers, sore throat, and difficulty swallowing.  On exam she has cervical and supraclavicular lymphadenopathy and bilaterally enlarged tonsils. Excisional biopsy of a cervical lymph node is shown.  image 

Wednesday, May 3

10Head/Neck50-year-old with parotid gland mass image
11Head/Neck50-year-old with sinonasal mass image
12Gyn28-year-old female presenting with a 16 cm ruptured ovarian mass.image
13Gyn40 year-old female with multiple (5) firm tan-white omental nodules ranging from 0.5-1.5 cm in greatest dimension.  Also right pelvic tumor 6.2 cm with whorled cut surface and 3.0 cm cystic cavity filled with blood.  Twenty years ago the patient had a hysterectomy and right salpingo-oophorectomy showing a low-grade endometrial stromal sarcoma and multiple leiomyomas.image 
14Head/Neck50-year-old with laryngeal massimage 
16Lung52-year old female present with left-sided pleural effusion and empyema. Biopsies from carina and pleura (scanned slide is from carina).image 
17Lung43-year old female. Shortness of breath for 4-5months. Symptoms improved with antibiotics and steroids, ? sarcoidosis. Biopsies from right upper and lower lobes.H&E 1
H&E 2

Thursday, May 4

24CV Pathology58-year-old woman presents with headache and scalp tenderness and undergoes temporal artery biopsy.image
25CV Pathology82-year-old man presents with a transient ischemic attack and is found to have a 1 cm mass on the aortic valve and was referred for surgical resection.image 
26DermpathA 79-yr old woman presents with a 2-3 yr history of progressive, asymptomatic yellow-pink colored plaques on her torso. Associated symptoms include eye pain and oral dysesthsias. Lesional skin biopsies were performed. PDF 
27DermpathA 64-yr old man presents with a 2-yr history of progressive asymptomatic papules on his face and extremities. He denies any associated constitutional symptoms including joint pains or stiffness, myalgias, shortness of breath or visual disturbances. Lesional skin biopsies were performed. PDF
28DermpathA 48-yr old man presents with a recurrent pruritic rash associated joint pains and low grade fever with night sweats. Lesional skin biopsy was performed.PDF
29Bone/Soft Tissue68/M with history of prostate carcinoma and s/p radiation presents with huge retroperitoneal mass. I have the slides for the biopsy, Post chemo resection (1 year later), and Recurrence in the prior surg site 7 years later.Image 1
Image 2
30Bone/Soft Tissue49 yo female nurse with mild hypertension. History of bee sting in the hand at age 5, after which, she slowly developed multiple nodules and masses extending proximally from the hand to the elbow. She has been treated without much success.  Lately, the lesions have become more painful, making her job difficult.Image 1
31Bone/Soft Tissue55 yo Female with history of breast carcinoma. Now she presents with a 3.3 cm mass in the anterior leg, involving the soft tissues and the underlying Tibia.Image 1
Image 2
Image 3

Friday, May 5

32GUA 22-year-old gentleman had an incidental discovery of a 2.5 left renal mass by imaging.   The patient underwent a partial nephrectomy. image
33GUA 61-year-old male presents with hematuria.  Urine cytologies were negative.  A cystoscopic biopsy is positive for small fragments of high-grade papillary urothelial carcinoma with extensive necrosis.  No muscularis propria is present.  A CT urogram revealed a large mass involving much of the anterior wall, 1.5 cm in maximal thickness, with probable extra cystic extension.  The patient undergoes a radical cystoprostatectomy with bilateral pelvic lymph node dissection and ileal conduit.   The scanned slide is a representative section of the bladder wall. image
34BreastA 77-year-old lady presents with a left breast mass and undergoes a needle core biopsy.  The findings of the core biopsy are presented.  The core biopsy is followed by a lumpectomy and sentinel lymph node biopsy.  The scanned slide is from one of the axillary sentinel lymph nodes.Biopsy H&E
Biopsy CK5
Resection H&E 1
Resection H&E 2 
35Renal 45 year old man with hematuria.H&E A4
H&E A6
36Renal 63 year old woman with bilateral renal masses.image
37RenalThe patient is a 61-year-old woman who was in her usual state of health until 1.5 years ago, when she had fatigue and was found to have anemia.  A subsequent medical evaluation revealed that she had diabetes, and she was started on metformin.  One year prior to the kidney biopsy, she was found to have a pancreatic tail mass, for which she underwent distal pancreatectomy and splenectomy. Two months prior to the kidney biopsy, she was found to have an elevated serum creatinine at 2.0 mg/dl.  Other laboratory results at the time of biopsy include negative ANA, normal serum C3 and C4, negative anti-MPO and anti-PR3, no monoclonal protein detected in the serum, slightly increased serum kappa to lambda free light chain ratio at 1.68, and urine protein to creatinine ratio 0.23 grams/gram. She had pyuria. The kidney biopsy and a section from the distal pancreatectomy are provided. H&E KR