Histopath Hub

35 years old female

Clinical details: Abdominal lump. CT scan - Large well-defined lobulated exophytic enhancing solid-cystic lesion (15.5 x 17.3 x 21 cm) at intraperitoneal location more on right side of abdomen. Non-enhancing internal necrotic areas within lesion.
CA-125 - 5.75 U/ml
CEA - 4.54 ng/ml
CA 19.9 - 1.3 U/ml

Specimen: Resection of retroperitoneal mass

Operative note: Intraoperative increase and fluctuation in blood pressure

Gross: Large encapsulated growth with solid to cystic, soft cut surface with tan to brown areas & multiple cysts filled with hemorrhagic fluid. External surface is tan to brown. Areas of hemorrhage & necrosis are present.

HP Diagnosis: Sympathetic Paraganglioma

60 years old male

Clinical details: Pain in abdomen since 1 month. Smoker & to***co chewer. Supraclavicular lymph nodes not palpable.
CT scan of thorax - well defined enhancing nodular lesion 17 x 16 mm in left lower lobe posterobasal segment abutting the corresponding segmental bronchiole & pulmonary artery branch.
Biopsy - Small cell neoplasm with neuroendocrine features.

Specimen: Left lower lobectomy
HP diagnosis: Typical carcinoid tumor

72 years old male

Clinical details: Ulcero-proliferative lesion in left buccal mucosa extending from angle of mouth to retromolar region.
CT scan of face - Well defined enhancing soft tissue density mass of 43 x 38 x 15 mm size involving left buccal mucosa. No significant cervical lymph nodes.

Specimen: Left buccal mucosa resection with upper alveolectomy & left supraomohyoid neck dissection.

Gross: Large verrucous lesion of 5.7 x 5 cm.

HP diagnosis: Squamous Cell Carcinoma, Conventional, Well differentiated

Follicular cystitis & intestinal metaplasia

Tunnel Clusters, Type B (cystic)

A common incidental microscopic finding in hysterectomy specimens.

Synchronous Dual Malignancy
Well differentiated squamous cell carcinoma of left buccal mucosa & papillary carcinoma of right lobe of thyroid gland.

38 years old male

Patient was being operated for Ca left buccal mucosa. Received frozen section of right level II-IV lateral neck nodes to rule out metastases.
In frozen section, Lymph nodes were negative for metastatic squamous cell carcinoma. Instead, metastatic papillary thyroid carcinoma was found incidentally in three lymph nodes.
Intra-operative USG was performed & small ill-defined suspicious lesion was detected in right lobe of thyroid gland.
Total thyroidectomy with left composite resection & bilateral modified neck dissection was performed.

Clinical details: Ulcerative lesion involving left buccal mucosa.
CT scan - ill-defined lesion 12 x 8 mm involving posterior alveolar process of mandible. Mandible bone involved.
Biopsy: Left buccal mucosa: Squamous cell carcinoma, well differentiated

HP Diagnosis:
Left composite resection with bilateral modified neck dissection & total thyroidectomy:
1) Left buccal mucosa - SqCC, WD, Multifocal.
2) Right lobe of thyroid gland - Papillary Carcinoma, Follicular variant, infiltrative (tumor size - 5 x 4 mm)

52 years old female

Clinical details: Postmenopausal bleeding. MRI - Mass lesion 25 x 27 x 42 mm involving endometrial cavity of lower uterus & endocervical canal, causing thinning of myometeium of anterior uterinal wall & anterior wall of cervix. There is suspicious loss of fat plane at posterior myometeium & posterior cervical wall. No evidence of parametrial or paracervical extension. Few prominent lymph nodes in bilateral internal iliac groups.

Specimen: Radical hysterectomy with infracolic omentectomy & bilateral pelvic lymph node dissection

HP diagnosis: Poorly differentiated adenocarcinoma of lower uterine segment & endocervix.

IHC: Endocervical carcinoma, poorly differentiated
CK7, p16 are positive.
CK20, vimentin, ER,PR are negative.

50 years old male

Clinical details: Nausea, jaundice. Smoker. CT scan - Well defined enhancing solid mass 3.1 x 3 x 1.5 cm noted at ampulla projecting into second part of duodenum. CBD dilated 19 mm. MPD 9 mm. Few gastric region lymph nodes. An enhancing periportal lymph node 16 x 9 mm. Serum
CA19.9 - 166.60 U/ml.
ERCP - Large periampullary growth ? malignant.

Biopsy: periampullary growth - Adenocarcinoma. G2: Moderately differentiated.

Specimen: Pylorus preserving pancreatico-duodenectomy (Whipple resection)

HP diagnosis:
Adenocarcinoma
G2: Moderately differentiated
Tumor extent - Tumor directly invades pancreas up to 0.5 cm.

16 years old male

Clinical details: Pain in abdomen, back pain & pedal edema. Fever few days ago. P/A - hepatomegaly.
CT scan - Liver is enlarged & shows multiple variable sized hypodense non-enhancing lesions within, largest lesion measures 74 x 69 mm in left lobe. Spleen is mild enlarged. Pancreas is diffusely bulky & non-enhancing. Multiple non-enhancing subcentimeter sized hypodense non-enhancing lesions in bilateral kidneys. Minimal ascites noted. Suggests possibility of neoplastic etiology ? Lymphoma ? Metastasis.
Serum CEA -

50 years old male

Clinical details: Hoarseness of voice since 1 month. Neck swelling since 6 months. Painful swallowing. Smoker. CT scan - Enhancing mass (2.5 x 2.8 x 2.3 cm) involving right paraglottic space, pyriform fossa, aryepiglottic fold with invasion of right lamina of thyroid cartilage & strap muscles of neck on right side. Multiple right cervical lymphadenopathy.

Biopsy - right pyriform fossa: squamous cell carcinoma, moderately differentiated, conventional

Specimen: Total laryngectomy with right pharyngectomy & bilateral modified neck dissection

HP diagnosis:
Squamous cell carcinoma, conventional
G2: moderately differentiated
Tumor extent - involves paraglottic space, cricoid cartilage, thyroid cartilage & strap muscle. Right lobe of thyroid gland & hyoid bone are uninvolved by tumor.

38 years old Female

Clinical details: Ascites. CT scan abdomen with pelvis - Well-defined multi-loculated cystic lesion arising from right adnexal region with multiple internal septation. No solid component. Size 21 x 19.4 x 10.6 cm. P/o Cystic ovarian neoplasm. CA125 - 34.2 U/ml.

Ascitic Fluid Cytology: Negative for malignant cell. Mucin present.

Specimen: Bilateral Salpingo- oophorectomy

Gross findings: Multi-loculated cyst containing thick gelatinous mucin with thin septation. No solid areas seen.

Frozen section diagnosis: At least Mucinous borderline tumor. Extensive sampling is required to rule out low grade malignancy.

HP Diagnosis: Mucinous Borderline Tumor

58 years old female

Clinical details: Known case of Ca mid esophagus. Completed Neo-adjuvant chemotherapy & radiotherapy.
Post treatment CT scan report - Esophageal wall thickness is within normal limits. No residual abnormal wall thickening involving esophagus.
Endoscopy - Esophageal stricture due to growth in mid esophagus from 24 to 28 cms. GEJ was at 37 cms.
Biopsy - Growth at mid esophagus: Squamous cell carcinoma, moderately differentiated

Specimen: Esophagectomy (post chemotherapy & radiotherapy)

HP diagnosis:
No residual tumor seen.
Treatment effect - present
Tumor regression score - No viable cancer cells (complete response, score 0)