1. Case 1 South Bay Pathology Society May 2009
Clinical History:
A 38 year old woman was seen for a left neck palpable nodule. A fine needle aspiration was performed and read as “Follicular cells consistent with follicular neoplasm”. A left thyroid lobectomy was performed. The gross specimen showed a multinodular thyroid with a 2.5 cm. dominant nodule in the left upper pole.

2. 2 1

3. 1

4. 2

5. 2 1

6. 1 2

7. Galectin 3

8. Galectin 3

9. CK 19

10. CK 19
CK 19

11. HBME-1

12. HBME-1
HBME-1

13. MIB-1
MIB-1

14. Case - 3 Clinical History:
A 53 year old man was seen for right-sided chest pain and shortness of breath. A chest X-ray showed a right pleural effusion with consolidation of the right lower lobe of lung. CT scan showed a mass extensively infiltrating the diaphragmatic and costal margin of the pleura. A core needle biopsy was performed that was signed-out as a “high-grade malignant spindle cell neoplasm suspicious for spindle cell sarcoma”. The patient continued to deteriorate and a right extrapleural pneumonectomy was eventually carried out.

21. CK AE1/AE3
Calretinin

22. MIB-1

23. S-100 Protein
SMA

24. Case 5 Clinical History:
A 36 year old woman was seen for a soft tissue mass in her left calf. The tumor measured approximately 8 cm. in greatest dimension. The patient had no history of trauma, or previous tumor or malignant neoplasm elsewhere. A surgical excision was carried out; a well-circumscribed 8 x 5.3 x 4.5 cm soft to rubbery tissue mass was excised with clear margins. The cut surface showed focally cystic and hemorrhagic gray-white soft tissue.

31. CK AE1/3

32. EMA showed an equally weak staining patter – almost like a blush…

33. S-100
CD34

34. BCL-2

35. Calponin

36. Case 7 Clinical History:
A 46 year old woman was seen for a raised, ill-defined area of induration in her left leg that had been slowly growing over a period of several months. A punch biopsy was carried out that was read at another institution as consistent with dermatofibroma. Three months later the patient developed inguinal lymphadenopathy and histologic examination of the resected lymph node revealed a metastatic malignant neoplasm. The skin lesion was re-examined and subsequently a wide excision was done.

38. Skin punch Bx.

39. Wide excision

46. S-100 Protein

47. Keratin AE1/3
Factor XIIIa

48. HMB45
Melan-A

49. KI-67

50. Case 9 Clinical History:
A 59 year old woman was seen for shortness of breath and chest pain. A CT scan showed an anterior mediastinal mass compressing the right lung. A core needle biopsy was interpreted as metastatic adenocarcinoma. An extensive clinical search for a primary failed to find any evidence of malignancy elsewhere. The patient was taken to surgery and a surgical excision of the tumor was undertaken.

58. KER AE1/3

59. MOC 31
CK19
CDX-2
CD117