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Special session
SPAP/ESP I- The best of Histopathology Clubs

September 2nd, 08.30-12.00 Auditorium II
Chairpersons: Rui Henrique (Portugal) and Paula Borralho (Portugal)
Case 1
Presented by: Ivan Damjanov, Kansas City,Kansas, United States

21-year old man with a nonseminomatous testicular germ cell tumor underwent orchidectomy and chemotherapy. Six months after the diagnosis he underwent retroperitoneal lymph node resection. Serum markers were within normal limits. The slides is from one of the retroperitoneal lymph nodes.
Yolk sac carcinoma 2Yolk sac carcinoma 1
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Case 2
Presented by: Marcello Franco, São Paulo, Brazil

Clinical data: Woman, 33 y/o. Torsion of the right ovary. Surgical specimen: a 6.5 cm diameter cyst, filled up by a brownish liquid. At the internal surface, an exophytic 3.5 cm diameter lesion was detected.
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Case 3
Presented by: Saul Suster, Milwaukee, United States

A 58 year old man without any significant previous history was seen for a slow-growing subcutaneous soft tissue mass in the gluteal fold of 2 years’ evolution. The lesion was surgically excised with clear margins. The gross specimen measured 7.5 x 6.0 x 4.3 cm and showed a well-circumscribed but unencapsulated mass 6.0 cm. in greatest diameter with a yellow-gray soft and glistening lobulated cut surface. There was no evidence of hemorrhage or necrosis.
Case 3, Slide 1Picture 1; H&E x 20Picture 2; H&E x 20Picture 3; H&E x 40Picture 4; H&E x 60Picture 5; H&E x 100Picture 6; IHC, CD34
Picture 7; H&E x 100Picture 8; H&E x 40
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Case 4
Presented by: Paula Borralho-Nunes, Almada, Portugal

The patient was a 66 yr man who presented with bilateral hearing loss, dizziness, postural imbalance, headache, dysphagia, diminished right superior limb strength, limitation of neck mobility, non-quantified weight loss and reduced visual acuity. He had no history of recent infectious diseases and denied fever, diarrhea, arthralgia or myalgia. He denied drinking alcohol or smoking and didn’t have a significant personal or familial medical history.

Examination demonstrated bilateral papilla oedema with vitritis, floaters, retinal haemorrhages and reduced visual acuity. Clinical examination showed posterior cervical contracture without meningeal signs, gait imbalance, right brachial hyperreflexia and hemiparesis.

The only laboratory anomalies found at this time were a mild anaemia (hemoglobin 10.8 g/dL), and an inflammatory syndrome [(C-reactive protein (CRP) 91.3 mg/L]. Infectious serology was negative (HBs, HIV, VDRL, CMV, EBV, Toxoplasma, Mycoplasma pneumoniae, borrelia) as well as Mantoux and tumour markers (PSA, CEA, Alfa-fetoprotein, CA 19.9, CA125).

MRI: Right cerebellar ischemic stroke.
CT Scan: Bilateral axillary adenopathy, retro-crural, celiac artery chain and small gastric curvature.

Excisional biopsy was performed for a slightly enlarged nontender right inguinal lymph node.
Slide 1H&E 10XHEx40HEx40-2 Ziehl-Neelsen 40xCD68x40PAS-D 40X
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Case 5
Presented by: Ondrej Hes, Plzen, Czech Republic

Case History: A 54-year-old female underwent partial resection of the right kidney for an asymptomatic tumor, which was incidentally discovered on ultrasonography performed in conjunction with a traffic accident. The patient is alive and well 6 years after nephrectomy.
Slide 1HES Slide 1 HEHES Slide 2 HEHES Slide 3 HEHES Slide 4 CK 7HES Slide 5 CK 5,6
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Case 6
Presented by: Marcello Franco, São Paulo, Brazil

Clinical data:

• Female, 29 year-old. Incidental finding of a renal solid tumor.
• Nephrectomy indicated by the urologist which was not accepted by the patient.
• Biopsy performed in November/2011.
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Case 7
Presented by: Saul Suster, Milwaukee, United States

A 53 year old man was seen for progressive chest pain and dyspnea. A chest X-ray showed widening of the mediastinum. A CT scan showed a well-circumscribed mass localized in the anterior mediastinum that measured 10x8x6 cm. There was no evidence of infiltration into the surrounding structures. A complete surgical excision was done.
Slide 1Picture 1; H&E x 20Picture 2; H&E x 40Picture 3; H&E x 20Picture 4; H&E x 20Picture 5; H&E x 40Picture 6; H&E x 40
Picture 7; H&E x 40Picture 8; H&E x 60
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Case 8
Presented by: Rui Henrique, Porto, Portugal

Eighteen year-old female, asymptomatic until 4 months before admission, complaining of abdominal pain. Imaging evaluation disclosed a solid and cystic tumour involving the stomach.The CT scan showed a tumor in the right abdominal quadrant containing cystic areas, septa and multiple foci of calcification, in close contact with the gastric wall. A partial gastrectomy was performed and the surgical specimen displayed a nodular, solid and cystic tumour with 10.5cm in largest dimension.
Slide 1 (HE)
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