https://peir.path.uab.edu/api.php?action=feedcontributions&user=Stephanie+Simmons&feedformat=atomPathology Education Instructional Resource - User contributions [en]2024-03-29T05:10:02ZUser contributionsMediaWiki 1.31.1https://peir.path.uab.edu/index.php?title=Cytologically_Yours:_Unknowns:_2014&diff=2895Cytologically Yours: Unknowns: 20142014-04-04T19:33:43Z<p>Stephanie Simmons: /* April */</p>
<hr />
<div>This is an index of all the Unknowns for 2014.<br />
<br />
==January==<br />
The theme of this month is: '''pancreas'''<br />
* [[Cytologically Yours: Unknowns: 201401: Case 1|Case 1]]<br />
* [[Cytologically Yours: Unknowns: 201401: Case 2|Case 2]]<br />
* [[Cytologically Yours: Unknowns: 201401: Case 3|Case 3]]<br />
* [[Cytologically Yours: Unknowns: 201401: Case 4|Case 4]]<br />
* [[Cytologically Yours: Unknowns: 201401: Case 5|Case 5]]<br />
* [[Cytologically Yours: Unknowns: 201401: Case 6|Case 6]]<br />
<br />
==February==<br />
<ppt>https://onedrive.live.com/embed?cid=7B0AC1C62FF7DD73&resid=7B0AC1C62FF7DD73%21151&authkey=&em=2&wdAr=1.7777777777777777</ppt><br />
<br />
==March==<br />
<ppt>https://onedrive.live.com/embed?cid=7B0AC1C62FF7DD73&resid=7B0AC1C62FF7DD73%21153&authkey=AFHBZKRBb0SCNvI&em=2&wdAr=1.3333333333333332</ppt><br />
==April==<br />
<ppt>https://onedrive.live.com/embed?cid=7B0AC1C62FF7DD73&resid=7B0AC1C62FF7DD73%21155&authkey=&em=2&wdAr=1.3333333333333333</ppt><br />
<br />
==May==<br />
<br />
<br />
==June==<br />
<br />
<br />
==July==<br />
<br />
<br />
==August==<br />
<br />
<br />
==September==<br />
<br />
<br />
==October==<br />
<br />
<br />
==November==<br />
<br />
<br />
==December==<br />
<br />
<br />
{{Cytologically Yours}}</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140227&diff=2802Cytologically Yours: CoW: 201402272014-03-04T23:10:29Z<p>Stephanie Simmons: /* Biopsy */</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 74 year old female with a history of sarcoma of the right thigh and a new lung mass. <br />
<br />
=== Past Medical History ===<br />
* Sarcoma of thigh (3 years prior)<br />
* Osteoarthritis<br />
<br />
=== Past Surgical History ===<br />
* Previous excision of thigh sarcoma. <br />
* Hysterectomy<br />
<br />
==Radiology==<br />
* CT showed a right upper lobe low density nodule measuring 3.0 x 2.6 cm which is abutting the pleural surface.<br />
<br />
===Clinical Plan===<br />
The patient was scheduled for an endobronchial ultrasound guided fine needle aspiration biopsy.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140227Cytology1.jpg|20x magnification showing adipose tissue, atypical cells and bubbly appearing nuclei.<br />
CytologicallyYoursCoW20140227Cytology2.jpg|20x magnification showing adipose tissue<br />
CytologicallyYoursCoW20140227Cytology3.jpg|60x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology4.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology5.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
<br />
</gallery><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, favor liposarcoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140227Biopsy1.jpg|20x magnification of pleomorphic nuclei and lipoblasts.<br />
CytologicallyYoursCoW20140227Biopsy2.jpg|40x magnification of pleomorphic nuclei and lipoblasts.<br />
<br />
</gallery><br />
<br />
===Previous Soft Tissue Biopsy Diagnosis===<br />
* '''High grade pleomorphic liposarcoma'''.<br />
<br />
<br />
===Discussion===<br />
The diagnosis of pleomorphic liposarcoma on cytology rests on the presence of highly atypical, sometimes multinucleated lipoblasts. The scalloped nucleus is an important diagnostic feature.<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140227&diff=2801Cytologically Yours: CoW: 201402272014-03-04T23:09:56Z<p>Stephanie Simmons: /* Biopsy */</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 74 year old female with a history of sarcoma of the right thigh and a new lung mass. <br />
<br />
=== Past Medical History ===<br />
* Sarcoma of thigh (3 years prior)<br />
* Osteoarthritis<br />
<br />
=== Past Surgical History ===<br />
* Previous excision of thigh sarcoma. <br />
* Hysterectomy<br />
<br />
==Radiology==<br />
* CT showed a right upper lobe low density nodule measuring 3.0 x 2.6 cm which is abutting the pleural surface.<br />
<br />
===Clinical Plan===<br />
The patient was scheduled for an endobronchial ultrasound guided fine needle aspiration biopsy.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140227Cytology1.jpg|20x magnification showing adipose tissue, atypical cells and bubbly appearing nuclei.<br />
CytologicallyYoursCoW20140227Cytology2.jpg|20x magnification showing adipose tissue<br />
CytologicallyYoursCoW20140227Cytology3.jpg|60x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology4.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology5.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
<br />
</gallery><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, favor liposarcoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140276Biopsy1.jpg|20x magnification of pleomorphic nuclei and lipoblasts.<br />
CytologicallyYoursCoW20140276Biopsy1.jpg|40x magnification of pleomorphic nuclei and lipoblasts.<br />
<br />
</gallery><br />
<br />
===Previous Soft Tissue Biopsy Diagnosis===<br />
* '''High grade pleomorphic liposarcoma'''.<br />
<br />
<br />
===Discussion===<br />
The diagnosis of pleomorphic liposarcoma on cytology rests on the presence of highly atypical, sometimes multinucleated lipoblasts. The scalloped nucleus is an important diagnostic feature.<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Cytology5.jpg&diff=2800File:CytologicallyYoursCoW20140227Cytology5.jpg2014-03-04T23:09:09Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Cytology4.jpg&diff=2799File:CytologicallyYoursCoW20140227Cytology4.jpg2014-03-04T23:08:56Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Cytology3.jpg&diff=2798File:CytologicallyYoursCoW20140227Cytology3.jpg2014-03-04T23:08:40Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Cytology2.jpg&diff=2797File:CytologicallyYoursCoW20140227Cytology2.jpg2014-03-04T23:08:27Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Cytology1.jpg&diff=2796File:CytologicallyYoursCoW20140227Cytology1.jpg2014-03-04T23:08:15Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Biopsy2.jpg&diff=2795File:CytologicallyYoursCoW20140227Biopsy2.jpg2014-03-04T23:08:02Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140227Biopsy1.jpg&diff=2794File:CytologicallyYoursCoW20140227Biopsy1.jpg2014-03-04T23:07:50Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140227&diff=2793Cytologically Yours: CoW: 201402272014-03-04T23:07:28Z<p>Stephanie Simmons: Created page with "== Clinical Summary == The patient is a 74 year old female with a history of sarcoma of the right thigh and a new lung mass. === Past Medical History === * Sarcoma of thigh..."</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 74 year old female with a history of sarcoma of the right thigh and a new lung mass. <br />
<br />
=== Past Medical History ===<br />
* Sarcoma of thigh (3 years prior)<br />
* Osteoarthritis<br />
<br />
=== Past Surgical History ===<br />
* Previous excision of thigh sarcoma. <br />
* Hysterectomy<br />
<br />
==Radiology==<br />
* CT showed a right upper lobe low density nodule measuring 3.0 x 2.6 cm which is abutting the pleural surface.<br />
<br />
===Clinical Plan===<br />
The patient was scheduled for an endobronchial ultrasound guided fine needle aspiration biopsy.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140227Cytology1.jpg|20x magnification showing adipose tissue, atypical cells and bubbly appearing nuclei.<br />
CytologicallyYoursCoW20140227Cytology2.jpg|20x magnification showing adipose tissue<br />
CytologicallyYoursCoW20140227Cytology3.jpg|60x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology4.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
CytologicallyYoursCoW20140227Cytology5.jpg|40x magnification showing bizarre appearing malignant cells with unusual bubbly nuclei and adjacent adipose tissue.<br />
<br />
</gallery><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, favor liposarcoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of pleomorphic nuclei and lipoblasts.<br />
CytologicallyYoursCoW20140206Biopsy1.jpg|40x magnification of pleomorphic nuclei and lipoblasts.<br />
<br />
</gallery><br />
<br />
===Previous Soft Tissue Biopsy Diagnosis===<br />
* '''High grade pleomorphic liposarcoma'''.<br />
<br />
<br />
===Discussion===<br />
The diagnosis of pleomorphic liposarcoma on cytology rests on the presence of highly atypical, sometimes multinucleated lipoblasts. The scalloped nucleus is an important diagnostic feature.<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140220&diff=2792Cytologically Yours: CoW: 201402202014-03-04T22:47:13Z<p>Stephanie Simmons: /* Cytology */</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 58 year old male with back and neck pain.<br />
<br />
=== Past Medical History ===<br />
* Cervical spondylosis<br />
* Hypertension<br />
* Hyperlipidemia<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* Ultrasound of the neck shows a solid interpolar nodule 1.8 x 1.6 cm in the left lobe of the thyroid. <br />
<br />
===Clinical Plan===<br />
Fine needle aspiration of the nodule is scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140220Cytology1.jpg|20x magnification of a cellular specimen with numerous follicles and absent colloid.<br />
CytologicallyYoursCoW20140220Cytology2.jpg|40x magnification with follicular cells forming microfollicular groups and inspissated colloid.<br />
CytologicallyYoursCoW20140220Cytology3.jpg|60x magnification with follicular cells forming microfollicular groups and inspissated colloid. Nuclear are crowded with overlapping. The nuclei are enlarged.<br />
CytologicallyYoursCoW20140220Cytology4.jpg|40x magnification with follicular cells forming a microfollicular group and inspissated colloid.<br />
CytologicallyYoursCoW20140220Cytology5.jpg|40x magnification of Pap stained material showing magnification with follicular cells forming microfollicular groups and inspissated colloid..<br />
CytologicallyYoursCoW20140220Cytology6.jpg|60x magnification of Pap stained material with microfollicles.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is the differential diagnosis?"> In a cellular thyroid lesion, follicular neoplasm, including adenoma and carcinoma, and cellular benign follicular nodule are in the differential. Also in the differential is the follicular variant of papillary carcinoma. </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Follicular neoplasm'''.<br />
<br />
<br />
<br />
===Discussion===<br />
The diagnostic criteria for follicular lesions are based on cellularity and the presence of colloid. Follicular lesions will be cellular with an absence of the variability in the size of the follicular groups, with a predominately microfollicular pattern. Colloid will be scant to absent, except for the presence of inspissated colloid in the center of follicular groups. There is often a disorganized, crowded follicular pattern with some nucleomegaly and nucleoli.<br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140220&diff=2791Cytologically Yours: CoW: 201402202014-03-04T22:46:09Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 58 year old male with back and neck pain.<br />
<br />
=== Past Medical History ===<br />
* Cervical spondylosis<br />
* Hypertension<br />
* Hyperlipidemia<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* Ultrasound of the neck shows a solid interpolar nodule 1.8 x 1.6 cm in the left lobe of the thyroid. <br />
<br />
===Clinical Plan===<br />
Fine needle aspiration of the nodule is scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140220Cytology1.jpg|20x magnification of a cellular specimen with numerous follicles and absent colloid.<br />
CytologicallyYoursCoW20140220Cytology2.jpg|40x magnification with follicular cells forming microfollicular groups and inspissated colloid.<br />
CytologicallyYoursCoW20140220Cytology3.jpg|60x magnification with follicular cells forming microfollicular groups and inspissated colloid.<br />
CytologicallyYoursCoW20140220Cytology4.jpg|40x magnification with follicular cells forming microfollicular groups and inspissated colloid.<br />
CytologicallyYoursCoW20140220Cytology5.jpg|40x magnification of Pap stained material showing magnification with follicular cells forming microfollicular groups and inspissated colloid..<br />
CytologicallyYoursCoW20140220Cytology6.jpg|60x magnification of Pap stained material with microfollicles.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is the differential diagnosis?"> In a cellular thyroid lesion, follicular neoplasm, including adenoma and carcinoma, and cellular benign follicular nodule are in the differential. Also in the differential is the follicular variant of papillary carcinoma. </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Follicular neoplasm'''.<br />
<br />
<br />
<br />
===Discussion===<br />
The diagnostic criteria for follicular lesions are based on cellularity and the presence of colloid. Follicular lesions will be cellular with an absence of the variability in the size of the follicular groups, with a predominately microfollicular pattern. Colloid will be scant to absent, except for the presence of inspissated colloid in the center of follicular groups. There is often a disorganized, crowded follicular pattern with some nucleomegaly and nucleoli.<br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology6.jpg&diff=2790File:CytologicallyYoursCoW20140220Cytology6.jpg2014-03-04T22:41:54Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology5.jpg&diff=2789File:CytologicallyYoursCoW20140220Cytology5.jpg2014-03-04T22:41:43Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology4.jpg&diff=2788File:CytologicallyYoursCoW20140220Cytology4.jpg2014-03-04T22:41:25Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology3.jpg&diff=2787File:CytologicallyYoursCoW20140220Cytology3.jpg2014-03-04T22:41:11Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology2.jpg&diff=2786File:CytologicallyYoursCoW20140220Cytology2.jpg2014-03-04T22:40:50Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140220Cytology1.jpg&diff=2785File:CytologicallyYoursCoW20140220Cytology1.jpg2014-03-04T22:40:34Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140220&diff=2784Cytologically Yours: CoW: 201402202014-03-04T22:36:16Z<p>Stephanie Simmons: Created page with "== Clinical Summary == The patient is a 58 year old male with back and neck pain. === Past Medical History === * Cervical spondylosis * Hypertension * Hyperlipidemia === Pa..."</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 58 year old male with back and neck pain.<br />
<br />
=== Past Medical History ===<br />
* Cervical spondylosis<br />
* Hypertension<br />
* Hyperlipidemia<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* Ultrasound of the neck shows a solid interpolar nodule 1.8 x 1.6 cm in the left lobe of the thyroid. <br />
<br />
===Clinical Plan===<br />
Fine needle aspiration of the nodule is scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140220Cytology1.jpg|40x magnification of highly atypical malignant appearing cells.<br />
CytologicallyYoursCoW20140220Cytology2.jpg|20x magnification showing osteoid formation.<br />
CytologicallyYoursCoW20140220Cytology3.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140220Cytology4.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140220Cytology5.jpg|40x magnification of osteoid.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is the differential diagnosis?"> In a cellular thyroid lesion, follicular neoplasm, including adenoma and carcinoma, and cellular benign follicular nodule are in the differential. Also in the differential is the follicular variant of papillary carcinoma. </spoiler><br />
* <spoiler text="What are the molecular features that differentiate follicular carcinoma and papillary carcinoma?>"> Follicular carcinoma show PAX8-PPAR gamma translocations and papillary carcinoma shows BRAF mutations and RET/PTC rearrangements. </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Follicular neoplasm'''.<br />
<br />
<br />
<br />
===Discussion===<br />
The diagnostic criteria for follicular lesions are based on cellularity and the presence of colloid. Follicular lesions will be cellular with an absence of the variability in the size of the follicular groups, with a predominately microfollicular pattern. Colloid will be scant to absent, except for the presence of inspissated colloid in the center of follicular groups. There is often a disorganized, crowded follicular pattern with some nucleomegaly and nucleoli.<br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2783Cytologically Yours: CoW: 201402132014-03-04T22:22:05Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma. </spoiler><br />
<br />
====Cell Block====<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.<br />
<br />
</gallery><br />
<br />
* <spoiler text="What stains do you order?"> We ordered PSA, CK7, and CA19.9. </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Metastatic prostate carcinoma'''.<br />
<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy2.jpg|20x magnification of PSA shows positive staining<br />
<br />
</gallery><br />
<br />
* CK7 Negative<br />
* CA19.9 Negative<br />
* PSA Positive<br />
<br />
<br />
===Discussion===<br />
Metastatic prostate carcinoma to the pancreas is rare; however, long term survival of prostate cancer may increase the incidence. Renal cell carcinoma is the most metastatic pancreatic tumor.<br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2782Cytologically Yours: CoW: 201402132014-03-04T22:18:51Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma. </spoiler><br />
<br />
====Cell Block====<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.<br />
<br />
</gallery><br />
<br />
* <spoiler text="What stains do you order?"> We ordered PSA, CK7, and CA19.9. </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Metastatic prostate carcinoma'''.<br />
<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy2.jpg|20x magnification of PSA shows positive staining<br />
<br />
</gallery><br />
<br />
CK7 Negative<br />
CA19.9 Negative<br />
PSA Positive<br />
<br />
<br />
===Discussion===<br />
Metastatic prostate carcinoma to the pancreas is rare.<br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2781Cytologically Yours: CoW: 201402132014-03-04T22:16:19Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma. </spoiler><br />
<br />
====Cell Block====<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.<br />
<br />
</gallery><br />
<br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Metastatic prostate carcinoma'''.<br />
<br />
<br />
<br />
===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2780Cytologically Yours: CoW: 201402132014-03-04T22:14:48Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What was the initial diagnosis on rapid interpretation?"> Adenocarcinoma. </spoiler><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Metastatic prostate carcinoma'''.<br />
<br />
<br />
===Cell Block===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.<br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2779Cytologically Yours: CoW: 201402132014-03-04T22:11:51Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is your initial diagnosis?"> This was initially called adenocarcinoma on rapid diagnosis during the endoscopic ultrasound guided procedure. </spoiler><br />
<br />
===Cell Block===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Biopsy1.jpg|40x magnification of cell block of pancreatic mass showing small glands with macronucleoli.<br />
<br />
* <spoiler text="What special stains do you order?"> </spoiler><br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Metastatic prostate carcinoma'''.<br />
<br />
<br />
<br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Biopsy2.jpg&diff=2778File:CytologicallyYoursCoW20140213Biopsy2.jpg2014-03-04T22:06:35Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Biopsy1.jpg&diff=2777File:CytologicallyYoursCoW20140213Biopsy1.jpg2014-03-04T22:06:18Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology4.jpg&diff=2776File:CytologicallyYoursCoW20140213Cytology4.jpg2014-03-04T22:05:26Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology6.jpg&diff=2775File:CytologicallyYoursCoW20140213Cytology6.jpg2014-03-04T22:04:41Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology5.jpg&diff=2774File:CytologicallyYoursCoW20140213Cytology5.jpg2014-03-04T22:04:20Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology3.jpg&diff=2773File:CytologicallyYoursCoW20140213Cytology3.jpg2014-03-04T22:04:01Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology2.jpg&diff=2772File:CytologicallyYoursCoW20140213Cytology2.jpg2014-03-04T22:03:42Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology1.jpg&diff=2771File:CytologicallyYoursCoW20140213Cytology1.jpg2014-03-04T22:03:02Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140213&diff=2770Cytologically Yours: CoW: 201402132014-03-04T22:02:10Z<p>Stephanie Simmons: Created page with "== Clinical Summary == The patient is a 66yo old male presenting with jaundice. === Past Medical History === * History of prostate cancer 5 years ago. * Hyperlipidemia * Chr..."</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 66yo old male presenting with jaundice.<br />
<br />
=== Past Medical History ===<br />
* History of prostate cancer 5 years ago.<br />
* Hyperlipidemia<br />
* Chronic back pain<br />
<br />
=== Past Surgical History ===<br />
* Prostatectomy (2009)<br />
* Thyroidectomy (2004)<br />
<br />
==Ultrasound==<br />
* Ultrasound of head of pancreas shows a 43mm x 23mm ill defined mass.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included pancreatic adenocarcinoma and metastatic prostate cancer.<br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140213Cytology1.jpg|10x magnification of large cohesive groups of cells.<br />
CytologicallyYoursCoW20140213Cytology2.jpg|40x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology3.jpg|20x magnification showing atypical cells with large irregular nuclei. <br />
CytologicallyYoursCoW20140213Cytology4.jpg|40x magnification showing large, markedly pleomorphic cells.<br />
CytologicallyYoursCoW20140213Cytology5.jpg|40x magnification of malignant cell groups.<br />
CytologicallyYoursCoW20140213Cytology6.jpg|60x magnification of malignant cells. Macronucleoli are easily identified.<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma. </spoiler><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''High grade sarcoma, favor osteosarcoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone.<br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology6.jpg.JPG&diff=2769File:CytologicallyYoursCoW20140213Cytology6.jpg.JPG2014-03-04T21:52:06Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology5.jpg.JPG&diff=2768File:CytologicallyYoursCoW20140213Cytology5.jpg.JPG2014-03-04T21:51:53Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology4.jpg.JPG&diff=2767File:CytologicallyYoursCoW20140213Cytology4.jpg.JPG2014-03-04T21:51:39Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology3.jpg.JPG&diff=2766File:CytologicallyYoursCoW20140213Cytology3.jpg.JPG2014-03-04T21:51:25Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology2.jpg.JPG&diff=2765File:CytologicallyYoursCoW20140213Cytology2.jpg.JPG2014-03-04T21:51:07Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Cytology1.jpg.JPG&diff=2764File:CytologicallyYoursCoW20140213Cytology1.jpg.JPG2014-03-04T21:50:54Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Biopsy2.jpg.JPG&diff=2763File:CytologicallyYoursCoW20140213Biopsy2.jpg.JPG2014-03-04T21:50:41Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140213Biopsy1.jpg.JPG&diff=2762File:CytologicallyYoursCoW20140213Biopsy1.jpg.JPG2014-03-04T21:50:28Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140206&diff=2761Cytologically Yours: CoW: 201402062014-03-04T21:45:08Z<p>Stephanie Simmons: /* Final Diagnosis */</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain. <br />
<br />
=== Past Medical History ===<br />
* Previously heathy<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Cytology1.jpg|40x magnification of highly atypical malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology2.jpg|20x magnification showing osteoid formation.<br />
CytologicallyYoursCoW20140206Cytology3.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology5.jpg|40x magnification of osteoid.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma. </spoiler><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''High grade sarcoma, favor osteosarcoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone.<br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140206&diff=2760Cytologically Yours: CoW: 201402062014-03-04T21:44:11Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain. <br />
<br />
=== Past Medical History ===<br />
* Previously heathy<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Cytology1.jpg|40x magnification of highly atypical malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology2.jpg|20x magnification showing osteoid formation.<br />
CytologicallyYoursCoW20140206Cytology3.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology5.jpg|40x magnification of osteoid.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="The radiologic differential diagnosis was between osteosarcoma and Ewing sarcma. What would be a possible diagnostic pitfall?"> The confusion between osteosarcoma and Ewing may occur with the small cell variant of osteosarcoma. </spoiler><br />
<br />
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<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20131202Biopsy1.jpg|20x magnification of bone biopsy showing sclerotic bone<br />
<br />
</gallery><br />
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===Biopsy Diagnosis===<br />
* '''Conventional high grade sarcoma, sclerotic type'''.<br />
<br />
<br />
===Discussion===<br />
The experience of FNA of osteosarcoma is mainly with conventional high-grade intramedullary sarcoma and to the rare high-grade surface osteosarcoma. Smears usually contain dissociated neoplastic cells and cell clusters. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140206Biopsy1.jpg&diff=2759File:CytologicallyYoursCoW20140206Biopsy1.jpg2014-03-04T21:31:16Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140206&diff=2758Cytologically Yours: CoW: 201402062014-03-04T21:25:49Z<p>Stephanie Simmons: </p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain. <br />
<br />
=== Past Medical History ===<br />
* Previously heathy<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Cytology1.jpg|40x magnification of highly atypical malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology2.jpg|20x magnification showing osteoid formation.<br />
CytologicallyYoursCoW20140206Cytology3.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology5.jpg|40x magnification of osteoid.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is your differential diagnosis?">These groups of cells demonstrate malignant appearing cells in a background of an otherwise benign appearing lymphoid background. The atypical cells are scattered, with large nucleoli and several binucleate forms. In addition, there seem to be an increased number of eosinophils in the background. The differential diagnosis includes Hodgkin lymphoma; however, the possibility of the large atypical cells being melanoma cannot be ruled out. </spoiler><br />
* <spoiler text="What ancillary tests would you recommend?">For this patient, we recommended that the radiologist perform a biopsy of the lesion so that it could be sent for immunohistochemical workup. Since the overall percentage of the atypical cells were low, we were worried that a cell block would not contain enough of the malignant cells for additional stains. We also sent the lymph node for flow since a hematologic malignancy was suspected; however, with Hodgkin lymphoma, we don't expect any diagnostic findings from flow cytometry.</spoiler><br />
* <spoiler text="What immunohistochemical stains would you do?">CD15, CD30, and PAX5 would stain tumor cells in Hodkin lymphoma. Mart1, HMB45, and S100 could be used to rule out melanoma. Other additional stain in a lymphoma versus melanoma workup might include CD3, CD20, and keratin.</spoiler><br />
<br />
<br />
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<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20131202Biopsy1.jpg|20x magnification of lymph node core biopsy.<br />
CytologicallyYoursCoW20131202Biopsy2.jpg|40x magnification of lymph node core biopsy. <br />
CytologicallyYoursCoW20131202Biopsy3.jpg|CD 15 with membranous staining.<br />
CytologicallyYoursCoW20131202Biopsy4.jpg|CD 30 with membranous staining. <br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Classical Hodgkin lymphoma, favor mixed type'''.<br />
** CD15 Positive in tumor cells<br />
** CD30 Positive in tumor cells<br />
** PAX5 Weakly positive<br />
** CD20 Positive in background lymphocytes<br />
** CD3 Positive in background lymphocytes<br />
** S100 Negative<br />
** Mart1 Negative<br />
** HMB45 Negative<br />
<br />
===Discussion===<br />
The features of Hodgkin lymphoma include atypical (Hodgkin cells) and Reed-Sternberg cells. The nucleus should be 3-4x the size of a small lymphocyte. In classic Hodgkin lymphoma, scattered eosinophils, plasma cells, histiocytes, and a predominately CD3+ lymphocyte population will be seen in the background. The immunophenotype of classic Hodgkin lymphoma shows CD15, CD30, MUM1, and weak PAX5 positivity. Histology is usually needed to subtype Hodgkin lymphoma. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140206Cytology2.jpg&diff=2757File:CytologicallyYoursCoW20140206Cytology2.jpg2014-03-04T21:25:14Z<p>Stephanie Simmons: Stephanie Simmons uploaded a new version of &quot;File:CytologicallyYoursCoW20140206Cytology2.jpg&quot;</p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_CoW:_20140206&diff=2756Cytologically Yours: CoW: 201402062014-03-04T21:24:27Z<p>Stephanie Simmons: Created page with "== Clinical Summary == The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits whi..."</p>
<hr />
<div>== Clinical Summary == <br />
The patient is a 12 year old female with a six month history of left shoulder pain. The patient had tried Aleve and had several chiropractic visits which were unsuccessful at relieving the pain. <br />
<br />
=== Past Medical History ===<br />
* Previously heathy<br />
<br />
=== Past Surgical History ===<br />
* No surgical history<br />
<br />
==Radiology==<br />
* AP/Lateral images show a destructive and aggressive appearing lesion in the left proximal huerus in the metaphysis extending 7.5cm distally in the diaphysis.<br />
<br />
===Clinical Plan===<br />
The differential diagnosis included osteosarcoma and Ewing sarcoma. MRI and CT guided biopsy are scheduled. <br />
<br />
==Pathology==<br />
<br />
===Cytology===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20140206Cytology1.jpg|40x magnification of highly atypical malignant appearing cells.<br />
CytologicallyYoursCoW201402062Cytology2.jpg|20x magnification showing osteoid formation.<br />
CytologicallyYoursCoW20140206Cytology3.jpg|40x magnification showing osteoid formation and malignant appearing cells.<br />
CytologicallyYoursCoW20140206Cytology5.jpg|40x magnification of osteoid.<br />
<br />
</gallery><br />
<br />
<br />
====Resident Questions====<br />
* <spoiler text="What is your differential diagnosis?">These groups of cells demonstrate malignant appearing cells in a background of an otherwise benign appearing lymphoid background. The atypical cells are scattered, with large nucleoli and several binucleate forms. In addition, there seem to be an increased number of eosinophils in the background. The differential diagnosis includes Hodgkin lymphoma; however, the possibility of the large atypical cells being melanoma cannot be ruled out. </spoiler><br />
* <spoiler text="What ancillary tests would you recommend?">For this patient, we recommended that the radiologist perform a biopsy of the lesion so that it could be sent for immunohistochemical workup. Since the overall percentage of the atypical cells were low, we were worried that a cell block would not contain enough of the malignant cells for additional stains. We also sent the lymph node for flow since a hematologic malignancy was suspected; however, with Hodgkin lymphoma, we don't expect any diagnostic findings from flow cytometry.</spoiler><br />
* <spoiler text="What immunohistochemical stains would you do?">CD15, CD30, and PAX5 would stain tumor cells in Hodkin lymphoma. Mart1, HMB45, and S100 could be used to rule out melanoma. Other additional stain in a lymphoma versus melanoma workup might include CD3, CD20, and keratin.</spoiler><br />
<br />
<br />
<div class="usermessage mw-customtoggle-diagnosis" style="cursor:pointer">Click here to toggle the diagnosis and discussion.</div><br />
<div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-diagnosis"><br />
<div class="mw-collapsible-content"><br />
<br />
==Final Diagnosis==<br />
===Cytology===<br />
* '''Positive for malignancy, the differential diagnosis includes melanoma and Hodgkin lymphoma'''.<br />
<br />
<br />
===Biopsy===<br />
<gallery heights="250px" widths="250px"><br />
CytologicallyYoursCoW20131202Biopsy1.jpg|20x magnification of lymph node core biopsy.<br />
CytologicallyYoursCoW20131202Biopsy2.jpg|40x magnification of lymph node core biopsy. <br />
CytologicallyYoursCoW20131202Biopsy3.jpg|CD 15 with membranous staining.<br />
CytologicallyYoursCoW20131202Biopsy4.jpg|CD 30 with membranous staining. <br />
<br />
</gallery><br />
<br />
===Biopsy Diagnosis===<br />
* '''Classical Hodgkin lymphoma, favor mixed type'''.<br />
** CD15 Positive in tumor cells<br />
** CD30 Positive in tumor cells<br />
** PAX5 Weakly positive<br />
** CD20 Positive in background lymphocytes<br />
** CD3 Positive in background lymphocytes<br />
** S100 Negative<br />
** Mart1 Negative<br />
** HMB45 Negative<br />
<br />
===Discussion===<br />
The features of Hodgkin lymphoma include atypical (Hodgkin cells) and Reed-Sternberg cells. The nucleus should be 3-4x the size of a small lymphocyte. In classic Hodgkin lymphoma, scattered eosinophils, plasma cells, histiocytes, and a predominately CD3+ lymphocyte population will be seen in the background. The immunophenotype of classic Hodgkin lymphoma shows CD15, CD30, MUM1, and weak PAX5 positivity. Histology is usually needed to subtype Hodgkin lymphoma. <br />
<br />
</div></div><br />
<br />
{{Cytologically Yours}}<br />
<br />
[[Category:Case Reports]]</div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140206Cytology5.jpg&diff=2755File:CytologicallyYoursCoW20140206Cytology5.jpg2014-03-04T21:19:18Z<p>Stephanie Simmons: </p>
<hr />
<div></div>Stephanie Simmonshttps://peir.path.uab.edu/index.php?title=File:CytologicallyYoursCoW20140206Cytology1.jpg&diff=2754File:CytologicallyYoursCoW20140206Cytology1.jpg2014-03-04T21:17:59Z<p>Stephanie Simmons: </p>
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<div></div>Stephanie Simmons