0.0

• Case order is randomized• A blank page precedes every diagnosis• Every diagnosis is verbatim from answer key• Case numbers

– 1-15: July 2010– 16-30: August 2010– 31-50: September 2010– 51-72: November 2010– 73-87: February 2011– 88-97: April 2011– 98-113: May 2011

57F, hysterectomy for uterine prolapse

Case 116.0

Case 116.1

Case 116.2

Case 116.3

16.4

16.5

• Cervical atrophy

Case 7

32F, LGSIL on Pap, HPV DNA+ by history.

Biopsy from cervix.

22.0

Case 722.1

Case 722.2

22.3

22.4

• Unremarkable ectocervix

Case 11

49M: Retroperitoneal/mesenteric mass

83.0

Case 1183.1

Case 1183.2

Case 1183.3

Case 1183.4

Case 1183.5

Case 1183.6

83.7

• Diagnosis

• Name the stain

83.8

Case 11.

2 Diagnosis: Fibromatosis

1 Name the stain: B-catenin

Case 12

FNA palpable breast mass

12.0

Case 1212.1

Case 1212.2

12.3

12.4

• Fibroadenoma

Bilateral ovarian masses

Case 8105.0

Case 8105.1

Case 8105.2

Case 8105.3

Case 8105.4

105.5

105.6

• Serous borderline tumor, typical

61F: Once again, a mass in front of the ear

Case 1060.0

Case 1060.1

Case 1060.2

Case 1060.3

Case 1060.4

Case 1060.5

60.6

60.7

• Myoepithelial carcinoma dd clear cell carcinoma, RCC, HCC but you would have to discuss and exclude (immunos for former, vascularity for latter)

Case 6

An invasive mammary carcinoma

78.0

Case 678.1

Case 678.2

78.3

• a. Name the stain

78.4

Case 6. An immunostain performed on an invasive breast carcinoma.

2 a. Name the stain: Her-2

46F Endometrial biopsy

Case 1126.0

Case 1126.1

Case 1126.2

Case 1126.3

Case 1126.4

Case 1126.5

26.6

26.7

• Extreme exogenous hormonal influence (progesterone)

Case 9

23 F, cervical biopsy

24.0

Case 924.1

Case 924.2

24.3

24.4

• HGSIL/CIN II

6M: Enlarged retro-auricular lymph node

Case 757.0

Case 757.1

Case 757.2

Case 757.3

Case 757.4

57.5

57.6

• Langerhan cell histriocytosis

55F complains of vulvar irritationVulva biopsy

Case 318.0

Case 318.1

Case 318.2

Case 318.3

18.4

18.5

• VIN3 with microinvasion

46F

Each ovary measures approximately 4 x 3 x 3 cm.

Cut surface is white and bosselated.

Case 15113.0

Case 15113.1

Case 15113.2

Case 15113.3

Case 15113.4

113.5

113.6

• Metastatic lobular carcinoma

Case 5

No history

77.0

Case 577.1

Case 577.2

Case 577.3

Case 577.4

Case 577.5

77.6

• a. Name the stain

• b. What is the diagnosis?

77.7

Case 5.

1 a. Name the stain: S-100

2 b. What is the diagnosis? Benign lymph node; no melanoma

Case 13

66M: Elevated PSA

85.0

Case 1385.1

Case 1385.2

Case 1385.3

Case 1385.4

Case 1385.5

Case 1385.6

85.7

• a. Most comprehensive diagnosis on sections provided

• b. Name the stain

85.8

Case 13.

2 a. Most comprehensive diagnosis on sections provided:

Ductal adenocarcinoma Gleason 4+4 score 8. Perineural invasion is present

1 b. Name the stain: P63

62F: Increasing abdominal girth

Case 1363.0

Case 1363.1

Case 1363.2

Case 1363.3

Case 1363.4

Case 1363.5

Case 1363.6

63.7

63.8

• Mucinous adenocarcinoma adherent/metastatic to spleen depending on whether you think that it is in the organ or not

Bilateral cystic ovarian masses

Case 299.0

Case 299.1

Case 299.2

Case 299.3

Case 299.4

Case 299.5

Case 299.6

Case 299.7

99.8

99.9

• Serous papillary cystadenofibroma

Case 20

45M: Dysphagia

50.0

Case 2050.1

Case 2050.2

Case 2050.3

Case 2050.4

50.5

50.6

• Herpses esophagitis

43F

Left ovarian mass 16 x 14 x 11 cm, 1139 gms

Solid and cystic cut surface

Case 14112.0

Case 14112.1

Case 14112.2

Case 14112.3

Case 14112.4

Case 14112.5

Case 14112.6

Case 14112.7

Case 14112.8

112.9

112.10

• Clear cell carcinoma

28F: Tissue designated as endometrial polyp

Case 1530.0

Case 1530.1

Case 1530.2

Case 1530.3

Case 1530.4

Case 1530.5

Case 1530.6

30.7

30.8

• Proliferative endometrium

Case 7

64F

94.0

Case 794.1

Case 794.2

Case 794.3

Case 794.4

Case 794.5

94.6

94.7

Case 15

20M: Rectal biopsy

45.0

Case 1545.1

Case 1545.2

Case 1545.3

45.4

45.5

• Non-nec granulomas AFB, GMS, r/o Crohn’s

Cystic ovarian mass

Case 12109.0

Case 12109.1

Case 12109.2

Case 12109.3

109.4

109.5

• Serous borderline tumor micropapillary

Case 2

28F: Right breast mass

2.0

Case 22.1

Case 22.2

Case 22.3

Case 22.4

Case 22.5

2.6

2.7

• Lactational change

Case 8

49M: Resection for metastases.

80.0

Case 880.1

Case 880.2

Case 880.3

Case 880.4

80.5

• a. Name the organ

• b. What is/are the most likely primary site(s)?

• c. This immunostain supports the phenotype of the metastasis. Name the stain

80.6

Case 8.

1 a. Name the organ: Liver

2 b. What is/are the most likely primary site(s)?

Esophagus, lung, head and neck

1 c. This immunostain supports the phenotype of the metastasis.

Name the stain: P63

Diarrhea

Case 2272.0

Case 2272.1

Case 2272.2

Case 2272.3

72.4

72.5

• cryptosporidiosis

Case 7

62M: History of treated acute myeloid leukemia.

Testicular mass

79.0

Case 779.1

Case 779.2

Case 7 b79.3

Case 7 c79.4

79.5

• a. What is the diagnosis?

• b. Name the stain

• c. Name the stain

79.6

Case 7.

2 a. What is the diagnosis? Seminoma

1 b. Name the stain: Oct3/4

1 c. Name the stain: PLAP/C-Kit

Case 8

32F: No history provided

38.0

Case 838.1

Case 838.2

Case 838.3

Case 838.4

38.5

38.6

• SIL (P16, MIB1) to CIN II/HGSIL

Case 1

No history

73.0

Case 173.1

Case 173.2

Case 1 a73.3

Case 1 b73.4

73.5

• Case 1. A section of breast tissue. Name the stains.

73.6

1 a. ER/PR

1 b. SMA/Smooth muscle heavy chain myosin/Caldesmon

Middle aged woman

Enormously enlarged unilateral multiloculated ovarian mass

Smooth lining, viscous contents

Case 4101.0

Case 4101.1

Case 4101.2

Case 4101.3

Case 4101.4

Case 4101.5

101.6

101.7

• Mucinous cystadenoma

62 F

Two masses in the ovary.

The first is homogenous, white and firm

It measures 2.5 x 1 x 1 cm

Case 13a110.0

Case 13a110.1

Case 13a110.2

Case 13a110.3

Case 13a110.4

Case 13a110.5

110.6

110.7

• Fibroma

The other mass is cystic with a smooth lining and an intramural nodule.

The cyst lining is smooth I made that up because somebody did not comment on the lining

Case 13b111.0

Case 13b111.1

Case 13b111.2

Case 13b111.3

Case 13b111.4

Case 13b111.5

Case 13b111.6

111.7

111.8

• Brenner tumor

Case 13

Calcifications in breast

43.0

Case 13

0.2 cm

43.1

Case 1343.2

Case 1343.3

Case 1343.4

Case 1343.5

Case 1343.6

43.7

43.8

• ADH from columnar lesion; Ca++

32F

Unilateral enlarged ovary

Approximately 7.0 cm

Cystic and solid

Case 6103.0

Case 6103.1

Case 6103.2

Case 6103.3

Case 6103.4

Case 6103.5

103.6

103.7

• Sertoli Leydig cell tumor

Case 2

49F: Breast biopsy for calcifications.

74.0

Case 274.1

Case 274.2

Case 274.3

Case 274.4

Case 274.5

Case 274.6

74.7

• a. Name the stain

• b. Most comprehensive diagnosis on sections provided:

74.8

Case 2.

1 a. Name the stain: E-cadherin

2 b. Most comprehensive diagnosis on sections provided:

Low grade DCIS

LCIS with comedo necrosis

Calcifications present in LCIS

Case 5

History of DCIS in this breast

5.0

Case 55.1

Case 55.2

Case 55.3

Case 55.4

Case 55.5

Case 55.6

5.7

5.8

• Radial scar, calcifications present

Case 14

No history

14.0

Case 1414.1

Case 1414.2

Case 1414.3

Case 1414.4

Case 1414.5

Case 1414.6

14.7

14.8

• Well diff neuroendocrine tumor

Case 9

Mastectomy specimen

9.0

Case 99.1

Case 99.2

Case 99.3

Case 99.4

Case 99.5

9.6

9.7

• Peripheral papillomas

Case 3

43F: Tumor, right wrist

90.0

Case 390.1

Case 390.2

Case 390.3

Case 390.4

Case 390.5

90.6

90.7

Case 3

55M: Tonsillar mass

75.0

Case 375.1

Case 375.2

Case 375.3

Case 375.4

75.5

• a. Most comprehensive diagnosis on sections provided

• b. Name the stain

75.6

Case 3.

2 a. Most comprehensive diagnosis on sections provided:

Basaloid squamous cell carcinoma

2 b. Name the stain: P16