CONSULTANTSFibroadenoma (with ductal epithelial hyperplasia/complex)Fibroadenoma with atypical epithelial hyperplasiaBenign Phyllodes (with epithelial hyperplasia)Benign proliferative breast lesion with usual type ductal hyperplasia and FEATubular carcinomaWell differrentiated invasive ductal carcinoma (tubular, sclerosing adenosis)

712111

Final analysis of NNDEQA 004 (May 2013 TSL workshops)

1) 70 year old female with focal irregularity in the right breast.

CONSUL TANTSFat necrosis (with organising thrombus/foreign body granuloma/surgical site reaction)Granulomatous with vasculitis

121

RESIDENTSFat n_ecrosis(traumatic)Chronic granulomatous mastitisDuct ectasiafibrocystic change with fat necrosis

15121

DIAGNOSIS: Haematoma and traumatic fat necrosis 32

2) Left breast lesion in adult female

RESIDENTSFibroadenoma (with ductal hyperplasia/epitheliosis/fibrocystic change/cystic mastopathy) 14Benign phyllodes tumour 3Fibrocystic changes 1Tubular carcinoma 1

DIAGNOSIS: Fibroadenoma 32

3) Right breast cyst 66 year old female

CONSULTANTSInvasive ductal carcinoma85 - (high grade) DCIS (with neuroendocrine features)Papillary carcinomaFirbocystic changes with atypical or usual ductal hyperplasiaAtypical ductal hyperplasiaUsual duct hyperplasia

432211

RESIDENTSInvasive ductal carcinomaAtypical ductal hyperplasia(lnvasive) papillary carcinomaSclerosing aden os is with florid ductal hyperplasiaAdenomyoepitheliomaMetastatic ovarian tumour

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DIAGNOSIS: Invasive ductal or papillary carcinoma accepted .32

CONSUL TANTS(chronic) Granulomatous mastitisGranulomatous mastitis probably TB, exclude fungal infectionGranuloma exclude sarcoid

553

4) Left breast lesion adult female.

RESIDENTSChr.onic granulomatous mastitisChronic granulomatous inflammation (most likely TB)Invasive ductal carcinomaTuberculous mastitis (AFB positive)

1062

DIAGNOSIS: Granulomatous mastitis (necessity to exclude TB/fungi accepted 32

5) Nipple abnormalities in a 50 year old female - nipple excised

CONSULTANTSDuctal/nipple/central papilloma (and florid papillomatosis)Invasive ductal carcinoma (with pagetoid spread/background papillomatosis)Duct ectasiaLobular carcinomaSubareolar sclerosing duct hyperplasiaPaget's disease of the nippleMicropapillary carcinoma

42221

RESIDENTSDuct ectasia (+columnar cell metaplasia)Invasive ductal carcinomaPaget's diseaseIntraductal papillomaNipple adenomaNo answerSclerosing lymphocytic mastitisInvasive lobular carcinomaPapillary cystadenomaNeurofibroma (dermal)

4333111111

DIAGNOSIS: Nipple involvement by infiltrating lobular carcinoma 32

CONSULTANTSChronic mastitis (fungal)Duct obstruction/duct ectasia/periductal mastitis (with abscess)Acute on chronic mastitis (with suppuration)Focus of malignancy surrounded by abscessFibroadenoma with cystic mastopathy

13711

6) Right breast lesion in adult female

RESIDENTSDuct ectasia/periductal mastitisDiabetic mastopathy/lymphocytic mastitisAcute on chronic mastitisChronic granulomatous inflammation (with fat necrosis)Breast abscessMixed invasive ductal and invasive lobular carcinomaChronic mastitis with sclerosing adenosisFibrocystic disease with acute on chronic mastitis

6423

DIAGNOSIS: Acute/chronic mastitis with periductal/lobular pattern and suppuration 32

7) Right breast lump in adult female

CONSULTANTS(Intermediate grade/micropapillary) DCISInvasive ductal carcinomaComedo carcinomaNeurofibromaAtypical ductal hyperplasia (micropapillary variant)Papillary carcinoma

541111

RESIDENTS'DCIS (papillary/micropaplllaryj/intraductal carcinoma 15Micropapillary carcinoma 2Intracystic papillary carcinoma 1Comedo carcinoma 1

DIAGNOSIS:High-grade DCIS with micropapillary pattern. No invasive tumour seen 32

8) Left breast lump in adult female.CONSULTANTS(complicated) fibrocystic disease (with ductal epithelial hyperplasia/periductal inflamm) 9Sclerosing adenosis (with cystic mastopathy) 1Apocrine metaplasia 1Ruptured galactocoele 1Mucin filled ducts FEA, CCC 1

RESIDENTSFibrocystic change (apocrine metaplasia/with usual duct hyperplasia)Apocrine adenosis (variant of sclerosing adenosis)/sclerosing adenosisRadial sclerosing lesionMicroglandular adenosisComplex fibroadenomaDIAGNOSIS: Focus of fibrocystic change with apocrine metaplasia

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CONSULTANTSIntraduct papilloma (with epithelial hyperplasia)PASHHormonal atrophy81unt duct aden os is82, benignDuctal hyperplasia84Sclerosinq aden os isMicroglandular hyperplasiaTubular adenomaLobular hyperplasia with ductal extension

31111111111

9) 44 year old woman, ? Fibroadenoma

RESIDENTSLobular neoplasia/Atypicallobular hyperplasiallobular carcinoma in-situInvasive (tubulo) lobular carcinomaDCISTubular adenomaStromal fibrosis and squamous metaplasiaIntraductal papillomaNo answer82, benignFlat epithelial atypiaFibrocystic disease (non-proliferative variant)PASHSclerosing adenosisMild intraductal hyperplasia

3222111111211

DIAGNOSIS: No definte lesion? Atrophic/filSrotic breast tissue 32

10) Right breast lump in a 68 year old woman.

CONSULTANTSInvasive lobular carcinoma (85, malignant) .Invasive ductal carcinoma (85, malignant)(neuroendocrine differentiation)Intraductal carcinoma

841

RESIDENTSInvasive ductal carcinoma (85b)Invasive lobular carcinomaneuroendocrine carcinomaMixed invasive lobular and ductal carcinomaSquamous cell carcinoma85, malignant

1051111

DIAGNOSIS: Mixed invasive ductal and invasive lobular carcinoma 32

CONSULTANTSDCIS (apocrine, high grade)Jintraductal carcinomaInvasive ductal carcinoma (with high grade DCIS)Medullary carcinomaChoriocarcinomaApocrine carcinoma

65111

11) 57 year old woman with malignant calcification on x-ray/mammography.

RESIDENTSDCIS (high grade, apocrine, choriocarcinomatous features)Jintraductal carcinomaInvasive ductal carcinoma (85b, from high grade DCIS)Atypical ductal hyperplasiaLCISNo answerMastitisMedullary carcinoma

9411111

DIAGNOSIS: High grade DCIS 32

12) 29 year old woman, 26 weeks pregnant? Fibroadenoma

CONSUL TANTSLactating adenomaJadenosis (82)83 - suspicious, probably benign (lactating adenosis)columnar cell change with atypia

1111

RESIDENTSLactating adenomaJadenosis (82) 19

DIAGNOSIS: Lactating adenoma/adenosis 32

13) Female 59 years, left micrododectomy/duct excision for bleeding left nipplewith ulcerated surface

CONSULTANTSPaget's disease with ductal carcinomaNipple adenomaDuct/intraductal papillomaDuct ectasia with epithelial hyperplasiaNo answer

53311

RESIDENTSIntraductal/duct papilloma 7Paget's disease with ductal carcinoma 6Usual duct hyperplasia 1Periductal mastitis 1No answer 2Nipple papillomatosis 1Intraductal papilloma with microinvasive ductal carcinoma 1

DIAGNOSIS: Benign skin adnexal tumour - Nevus sebaceous/syringocystadenoma 32

14) Right breast biopsy from? Recurrence after radiotherapy to treat previousneoplastic lesion. Female 69 years. MACROSCOPY: Skin ellipse 65 x 37 mmwith underlying fibrofatty tissue 52 x 35 x 26 mm. 2 skin lesions 10 and 4 mm inmaximum dimension respectively are separated by 3 mm of normal tissue.

CONSULTANTSAngiosarcomallymphangiosarcomaKaposi sarcomaRadiotherapy effectMalignant haemangiopericytomaMetaplastic carcinoma/angiosarcoma

RESIDENTSAngiosarcomaKaposi sarcomaLow grade stromal/soft tissue sarcoma (?fibrosarcoma)Stromal sarcoma/angiosarcomaHaemangiopericytomaMetaplastic carcinomaNo answerMalignant spindle cell tumour

DIAGNOSIS: Angiosarcoma

82111

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15) Left breast lump in a 47 year old female. Clinically and radiologically benign.Core biopsy - B3 ? Phyllodes, therefore excised with cuff of normal tissue around.MACROSCOPY: Tissue fragments 29 x 26 x 19 mm and 7 g.

CONSULTANTS(Giant) fibroadenomaSclerosing adenosisTubular adenoma _Cellular fibroadenomaBenign Phyllodes tumourSclerosing adenoma with atypiaMicroglandular adenosis

RESIDENTS

Fibroadenoma (complex, fibroadenomatoid hyperplasia)Sclerosing aden os isFibrocystic diseaseTubular adenomaBenign PhyllodesJuvenile fibroadenoma

DIAGNOSIS: Cellular or juvenile fibroadenoma

3322111

842221

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CONSUL TANTSFollicular lymphoma (no grade stated)No answerFollicular lymphoma grade 2ReactiveHodgkin's lymphoma

73111

16) Submental lymph node from female 63 years. ? LymphadenitisIMMUNOHISTOCHEMISTRY: Lesional cells express CD20, CD10 and Bcl-2. Presence ofneoplastic FDC meshwork confirmed with CD23.

RESIDENTSFollicular (centre cell) lymphoma (no grade stated)No answerAngioimmunoblastic lymphadenopathyFollicular carcinoma

11521

DIAGNOSIS: WHO grade 1-2 follicular non-Hodgkin's 8-ceU lymphoma 32

17) Axillary lymphadenopathy 32 year old male.IMMUNOHISTOCHEMISTRY: Tumour cells express CD30, CD15 and EBV-LMP1 but arenegative with CD45.

CONSULTANTSHodgkin's lymphoma (nodular sclerosis, classical, lymphocyte rich)No answer

112

RESIDENTSHodgkin's lymphoma (nodular sclerosis, classical, mixed cellularity, lymphocyte rich) 12No answer 5Diffuse B-ceillymphoma with sclerosis 2

DIAGNOSIS: Nodular sclerosing classical Hodgkin's lymphoma 3218) Left axillary lymph: nodes biopsy in a 62 year old female with mediastinal mass andsuperior vena cava obstruction. ? LymphomaIMMUNOHISTOCHEMISTRY: Not yet done

CONSULTANTSSinus hyperplasia/sinusoidal histiocytosis (+paracortical hyperplasia)No answerMetastatic carcinomaLow grade lymphomaReactive hyperplasia

82111

RESIDENTSNo answerSinus histiocytosis (reactive hyperplasia)Metastatic carcinomaNon-Hodgkin's lymphoma (low grade)Mediastinal (thymic) large B-ceillymphomaChronic lymphadenitisFibrohistiocytosis

6532111

DIAGNOSIS: Sinus histiocytosis - reactive lymphadenopathy 32

CONSULTANTS(Reactive) follicular hyperplasiaNo answerNon-Hodgkin's lymphoma (probably Burkitt)(Reactive) paracortical hyperplasiaReactive hyperplasiaHIVassociated lymphadenopathy

422221

19) Enlarged lymph node from the neck of a 12 year old female.IMMUNOHISTOCHEMISTRY: Not yet done

RESIDENTS(Reactive, explosive) follicular hyperplasiaNo answerDiffuse B-ceillymphoma (sinusal types)Kikuchi necrotising lymphadenitis

10621

DIAGNOSIS: Reactive (follicular/paracortical) hyperplasia with folliclular lysis. 32

20) Left axillary lymphadenopathy in 45 year old female. No breast mass and no skinlesions. ? Lymphoma.IMMUNOHISTOCHEMISTRY: CD20 positive areas well demarcated from CD5 positiveareas. Follicle germinal centres negative with Bcl-2.

CONSULTANTSDermatopathic lymphadenopathy (reactive)No answerMantle cell lymphomaReactive (?chronic lymphadenitis, sinus histiocytosis)Follicular hyperplasla .Atypical hyperplasia (?HIV)Non-Hodgkin's lymphoma

4222211

RESIDENTSNo answerDermatopathic lymphadenopathy (reactive)Reactive (follicular and parafollicular) hyperplasiaDiffuse B-ceillymphomaMantle cell lymphomaMetastatic melanoma

743211

DIAGNOSIS: Dermatopathic lymphadenopathy 32

21) Enlarged cervical lymph node in 52 year old male. ? Reactive lymphadenopathy.IMMUNOHISTOCHEMISTRY: Tumour cells express CD20 with weak expression of Bcl-2and very weak focal expression of MUM-1. Ki-67 index is nearly 100%. There is noexpression of CD10, cyclin D1 or EBV-lMP1. CD5 marks a very small population ofreactive lymphocytes.

CONSULTANTSDiffuse large B-cell lymphoma (NHl - large B-cell type)No answer 'Non-Hodgkin's lymphomaBurkitt's-like lymphomaMetastatic carcinoma (from small cell carcinoma of lung)Reactive

RESIDENTSDiffuse large B-cell lymphomaNo answerT cell/Histiocyte rich B cell lymphomaNon-Hodgkin's lymphoma? Necrotising inflammationBurkitt lymphomaKikuchi necrotising lymphadenitis

DIAGNOSIS: High grade diffuse large 8 cell non-Hodgkin's lymphoma

622111

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22) Right infraclavicular lymph node from a 62 year old male.IMMUNOHISTOCHEMISTRY: lesional cells express CD20, CD5 and CD23

CONSULTANTSSmall lymphocytic Iymphoma/CllNo answerMantle cell lymphomaNon-Hodgkin's lymphoma

RESIDENTSSmall lymphocytic Iymphoma/CllNo answerAnaplastic lymphomaDermatopathic lymphadenitisSmall lymphocytic lymphoma (mantle)Reactive

DIAGNOSIS: 8 small cell lymphocytic lymphoma/ell

7222

862111

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23) Bladder tumour resection in a 77 year old female who presented with suprapubic pain.Cystoscopy findings included grossly thickened bladder wall and cavity filled with tumour.IMMUNOHISTOCHEMISTRY: Tumour cells are negative for Bcl-2 but express CD20 andCD10 with a Ki-67 index of 100%. CD5 marks a very small population of reactivelymphocytes.

CONSUL TANTSBurkitt's lymphomaNo answerMarginal zone (extranodal) lymphomaMetastatic carcinomaDiffuse large B-cell lymphomaSmall cell carcinoma

RESIDENTSBurkitt's lymphomaNo answermetastatic transitional carcinomaFollicular B-ceillymphomaB-ceillymphoma unclassifiableHodgkin's lymphoma and high grade transitional cell carcinoma

DIAGNOSIS: High grade B-cell non-Hodgkin's lymphoma of Burkitt's type

631111

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24) Incidental finding of enlarged right level II jugular lymph node in a 72 year old male.IMMUNOHISTo.CHEMISTRY: Tumour cells are negative with CD10, but express CD20 andBcl-2. Neoplastic FDC meshwork identified with CD23.

CONSULTANTS'No answerFollicular lymphoma (no grading)large B-cell lymphomaNon-Hodgkin's lymphoma B-cell typeMarginal zone lymphomaFollicular lymphoma (grade 3)

RESIDENTSNo answerFollular (centre cell) lymphoma (no grading)B-cell ell (Sll)Hodgkin's lymphomaDiffuse large B-ceillymphomaFollicular (centre cell) lymphoma (grade 3)Primary mediastinal large B-ceillymphomaFollicular dendritic cell sarcomaSmall B-ceillymphoma (nodular variant)

DIAGNOSIS: WHO grade 3B follicular non-Hodgkin's lymphoma

442111

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2S) Axillary mass from a 32 year old male. History of radiotherapy since April 2011 formultiple myeloma diagnosed after spinal-cord operation.IMMUNO: tumour cells are strongly and uniformly CD30 positive with very focal strongexpression of CD1S. They are negative for CD4S, EBV-LMP1, CD20, CD79a, CD3, CD4,CDS, CD8 and ALK-1.CONSULTANTS

Anaplastic large cell lymphoma (Alk -ve)/High grade anaplastic NHLHodgkin's lymphoma (mixed cellularity)No answerMultiple myelomaAmelanocytic melanomaAnaplastiC large B-cell lymphoma

RESIDENTSHodgkin's lymphoma (nodular sclerosis, classical)No answerAnaplastic large cell lymphoma (ALK -ve)LymphoplasmacytomaB-ceillymphomaDiffuse large B-ceillymphoma (immunoblastic)Nodular lymphocyte predominance Hodgkin's lymphoma

DIAGNOSIS: Lymphocyte depleted classical Hodgkin's lymphoma

S321

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List of participants

CONSUL TANTS

ADAAadeboyADOATBUT@2013AJD1123DeleEda omoF2DgbfsOvayozaSophieT-Toxy

RESIDENTS1278daySsigmaAcMeATURU 44GCCTH ABCD

- GNJ.CLLL

olumoovaREDHORSEstunt101the donTaBUBEYoung PathologistZincNgbeaUmar

STATES REPRESENTEDLAGOSAkwa IbomAnambraBauchiEdoEnuguKanoKwaraOyoPlateau

II