26/04/2008 - Mogi Mirim

DIAGNÓSTICOS

1. A223-1 EPM – Case # 1. C08/323 
08/323 – 60 y/o man with an isolated enlarged cervical lymph node.
The abdominal magnetic imaging showed involvement of the liver, spleen and mesentery. Cell-block of the cytology of the ascites.
Diagnosis: Plasmacytoma (effusion-simile)
(CD138 positive, diffuse and intense; Kappa & Lambda negative; CD20, CD30, AE1-AE3 negative; an excised lymph node showed similar alterations. The patient died sooner after admission to the Hospital; and autopsy was not performed). In the meeting, it was suggested to do ISHybridization for EBV. This result will be shown in the next meeting.

2. A223-2 – Hospital de Cancer de Barretos 
46 y/o, man. Exophytic growth in the middle section of the tongue. Pyogenic granuloma?  
Diagnosis: Metastatic synovial sarcoma. The primary in the leg was resected in 2004. (AE1-AE3, Ck7, EMA, Vim, Ca125 positive; Muscle markers negative) (only 8 cases reported of  SS primary in the tongue).           

3. A223-3 – EPM – Case # 2- B07/3995
B07/3995 – 68 y/o man. Diffuse thyroid enlargement, with a white-gray    appearance, elastic consistency, with coarse white bands crossing through. No discernible nodules. No pulmonary or other malignancy on CT scan. 
Diagnosis: Papillary carcinoma, with massive intra-glandular dissemination (TTF-1, thyroglobulin, Ck7 positive; Ck20, calretinin negative). No primary tumor detected elsewhere.     

4. A223-4 – PATOCITO–Bahia (Hospital Aliança – A807/2622  
72y/o, woman. Pulmonary nodule. Treatment for tuberculosis. 
Tumor? Tuberculosis?  
Diagnosis: 
Previous history of tuberculosis (Ziehl positive) under treatment residual lung granulomas.
–Multifocal bronchioloalveolar carcinoma in the setting of typical and atypical adenomatous hyperplasia (case seen in consultation by Dr. Michael Bakker).            

5. A223-5 – Belo Horizonte – B55881/07
Woman. 32 y/o
A CNS tumor in the posterior fossa
Diagnosis: Clear cell meningioma (EMA, P Receptor, ki-67 (9%) positive (see Am. J. Surg. Pathol. 2007; 31:1813). 

6. A223-6 – Salomão e Zoppi – IH i04/292 
8y/o, girl. A 1.4 cm in diameter nodule in the lateral soft tissue of the thigh. 
Diagnosis: Myoepithelial carcinoma of the soft tissue (Vim, AE1-AE3, EMA, CD99, S-100, GFAP positive, diffuse or focal) (Case seen in consultation by Dr. Chris Fletcher: case # 16 in his recent publication -(Am. J. Surg. Pathol. 2003; 27: 1183; 2007; 31: 1813).       

7. A223-7 – Porto case – H06/7901
H06/7901 – 52 y/o, man. Nodule in the right adrenal (5.5 x 1.2 cm).
Incidental finding. 
Diagnosis: Adrenal gland with adenomatoid tumor and myelolipomatous focus (AE1, Vim, EMA, calretenin positive) (Urology 2005; 65: 175).        

8. A223-8 – Bauru 
21y/o, woman. A congenital pigmented, nodular lesion in the inguino-crural region of the thigh (superior-internal side, close to the perineal area).  
Diagnosis: Compound, congenital, melanocytic nevus with dysplasia at the dermo-epidermal junction (atypical melanocytic neoplasia) (the margins were re-excised) (S-100, Melan-A, HMB-45 positive).            

9. A223-9 – PATMED – B5396/07
Woman. Cutaneous asymptomatic, slow growing lesion in the left tight.
Clinical diagnostic hypotheses: Verrucous nevus? Keratoacanthoma ? The excised lesion measured 8 mm and was grayish at the periphery and yellowish at the central part. At the cutting surface, it was yellowish and measured 4 mm thick. 
Diagnosis: Benign histologic proliferation of a non-Langerhans cell differentiation/ origin (CD45, PAS, CD1a negative; CD68, Vim, S-100 positive, diffuse or focal. The case showed an IHC profile which did not fit completely with the related entities: Rosai-Dorfman, Xathoganuloma, Reticulohistiocytoma, Juvenile xanthoganuloma.      

10. A223-10 – LAPAC- UFederalGDourados  – the images will be e-mailed to you  soon.      
Diagnosis: Oral larva migrans (Ancylostoma brasiliensis). Rare cases described in the mouth.