23 February 2021: Image Quiz #50

Authors: Zachary Dong, M.D.Kimberley J. Evason, M.D., Ph.D.

Which of the following is true about this liver lesion?

Select an answer:

A. It usually communicates with intrahepatic bile ducts

B. The epithelium is usually CK20+

C. The stroma is usually ER / PR-

D. There is a strong female predominance

E. These lesions are most commonly multifocal

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9 February 2021: Image Quiz #49

Authors: Jennifer Pors, M.D.Lynn Hoang, M.D.

Which immunohistochemical staining profile would you expect in the cervical neoplasm depicted in this image?

Select an answer:

A. PAX8-, ER-, GATA3+, AMACR+

B. PAX8+, ER-, GATA3+, napsin A-

C. PAX8+, ER+, GATA3-, napsin A-

D. PAX8+, ER-, napsin A+, AMACR+

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26 January 2021: Image Quiz #48

Authors: Cade Arries, M.D., Elizabeth Courville, M.D.

A 45 year old man with a history of renal transplant presented with lymphadenopathy. A lymph node biopsy was performed. A representative image is shown. The large atypical cells are positive for CD30 and CD15 with dim PAX5 nuclear positivity and dim and variable CD20 expression. CD3 and CD45 are negative. Which of the following is the most appropriate diagnosis?

Select an answer:

A. Classic Hodgkin lymphoma posttransplant lymphoproliferative disorder

B. Monomorphic posttransplant lymphoproliferative disorder (diffuse large B cell lymphoma)

C. Nondestructive posttransplant lymphoproliferative disorder (florid follicular hyperplasia)

D. Polymorphic posttransplant lymphoproliferative disorder

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12 January 2021: Image Quiz #47

Author: Jian-Hua Qiao, M.D.

An 80 year old Caucasian woman had a thyroid mass and a 1 cm pulmonary lesion. CT guided transthoracic needle biopsy was performed to rule out metastatic tumor. Microscopic examination of core needle biopsy tissue reveals the following lesion. What is your diagnosis?

Select an answer:

A. Metastatic thyroid papillary carcinoma

B. Minute pulmonary meningothelial-like nodule

C. Pulmonary carcinoid tumor

D. Pulmonary meningioma

E. Pulmonary paraganglioma

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29 December 2020: Image Quiz #46

Authors: Aysha Mubeen, M.D.Arun Gopinath, M.D.

The grossing protocol for examination of the fallopian tube to identify the diagnosis in the photomicrograph should:

Select an answer:

A. Ensure complete evaluation of the fallopian tube in all cases

B. Increase detection of precursor lesions in at risk women

C. Require multistep levels in at risk women

D. Require tangential sectioning of the infundibulum and fimbrial segment to allow maximal exposure

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15 December 2020: Image Quiz #45

This is a liver biopsy from a patient who has a pancreatic mass. What is your diagnosis?

Answer – Metastatic pancreatic ductal adenocarcinoma. 

Comment – This pancreatic ductal adenocarcinoma has spread to the liver and “colonized” a bile duct in a portal tract. A separate bile duct in the same postal tract is unaffected. The malignant nuclei show loss of SMAD4/DPC4, a useful finding for this tumor (Am J Surg Pathol 2000;156:37).

This case was provided by Dr. Elizabeth Montgomery, Professor of Pathology and Vice Chair of Anatomic Pathology at the University of Miami and Editor-in-Chief of the Pathology Survival Guides at Innovative Pathology Press / Innovative Science.

The Survival Guide to Liver Pathology will be released soon! Order your copy at https://www.innovativesciencepress.com/product-page/survival-guide-to-liver-pathology.

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1 December 2020: Image Quiz #44

Authors: Gahie Nam, M.D.Kamaljeet Singh, M.D.

A 59 year old woman had a 1.0 cm spiculated breast mass, represented below. Tumor cells express GCDFP-15, mammaglobin, S100 and calretinin. Hormone receptors (ER / PR / HER2) are triple negative. Myoepithelial markers (p63 and SMMHC) are also negative. Other negative markers include TTF1 and thyroglobulin. What is the most common molecular alteration seen in these tumors?

Select an answer:

A. BRAF mutation

B. CDH1 mutation

C. IDH2 R172 hotspot mutations

D. RET mutation

E. TET2 truncating mutation

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17 November 2020: Image Quiz #43

Authors: V. Claire Vaughan, M.D.Joshua Wisell, M.D.

An elderly man presents to the dermatology clinic with a flesh colored papule over the lateral cheek without arborizing vessels or crust. Biopsy is shown. What is the most likely diagnosis?

Select an answer:

A. Basal cell carcinoma

B. Basaloid follicular hamartoma

C. Syringoma

D. Trichoblastoma

E. Spiradenoma

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3 November 2020: Image Quiz #42

Authors: Fenghua Peng, M.D., Ph.D.Jonathan E. Zuckerman, M.D., Ph.D.

Which of the following is true about IgG4 related disease in the kidney?

Select an answer:

A. Always involves the kidney diffusely

B. Dense lymphoplasmacytic cell infiltration is common

C. Interstitial inflammation and fibrosis are usually absent

D. Most patients tend to be young women

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20 October 2020: Image Quiz #41

Authors: Rong Xia, M.D., Ph.D.Xuchen Zhang, M.D., Ph.D.

Which of the following molecular features is associated with macrotrabecular massive hepatocellular carcinoma?

Select an answer:

A. TP53 mutation or FGF19 amplification

B. CTNNB1 mutations

C. RB1 mutation

D. Chromosomal alteration

E. TERT promoters mutation

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