Pathology Commons^™

Disseminated Peritoneal Leiomyomatosis Mimicking Carcinomatosis, Matthew Lee, Gabriella Morey, Susana Ferra

East Florida Division GME Research Day 2024

No abstract provided.

A Challenging Diagnosis: A Rare Variant Of Primary Lung Adenocarcinoma With Desquamative Interstitial Pneumonia-Like Morphology, Laura Luu, Maritess Dejesus, Christina Kovacs, Renu Khode

West Florida Division GME Research Day 2024

No abstract provided.

Ominous Mediastinal Mass Revealing Ectopic Thyroid, Cameron Summers, Gabriella Morey, Susana Ferra

East Florida Division GME Research Day 2024

Introduction: This report describes an asymptomatic 63-year-old female with a right paratracheal mass compressing and displacing the trachea to the left. Additionally, the epidemiology, clinical manifestation, diagnosis, and management of mediastinal ectopic thyroids are discussed.

Case Summary: A 63 y/o female with history of hypertension, myasthenia gravis and Type 2 diabetes mellitus had a hospitalization for pneumonia and was incidentally found via chest CT scan with a right paratracheal soft tissue mass with few coarse calcifications measuring 7.5 cm displacing the trachea to the left without compromise of the lumen. She was referred to a local cardiothoracic surgeon and underwent …

A Case Of Chronic Appendiceal Intussusception Secondary To Unsuspected Endometriosis, Matthew Lee, Susana Ferra

East Florida Division GME Research Day 2024

Introduction: Intussusception of the appendix is an exceedingly rare pathology with an incidence of 0.01%.

Case Summary: Patient is a 55 y/o female with appendiceal intussusception on CT and endoscopy. She was admitted for elective laparoscopic appendectomy, a distorted area involving the cecum and terminal ileum was identified. Procedure was converted to an open ileocolic resection due to the unclear anatomy and concern for possible malignancy. An intraoperative consultation revealed an inverted appendix.

Results: Gross examination of the specimen showed a structure protruding into the cecum lumen with an intact mucosal surface. Microscopic examination revealed a central fibromuscular core with …

Primary Squamous Cell Carcinoma (Scc) Of The Sigmoid Colon: A Rare Location & Histological Subtype Of Colorectal Carcinoma (Crc), Astrid Sacasa, Stachyse Stanis, Mohtashim Naeem

East Florida Division GME Research Day 2024

Introduction. Primary squamous cell carcinoma (SCC) of the colon is a rare histological subtype of CRC with poor prognosis. It most frequently occurs in the right colon, and least commonly in the sigmoid colon. Similar CRC symptoms no matter the subtype can range from asymptomatic to rectal bleeding, abdominal pain, change in bowel habits, and weight loss. Here, we describe a case of primary basaloid SCC of the sigmoid colon.

Case description. A 71-year-old female with no significant past medical history presented with guaiac-positive stools, underwent a colonoscopy revealing an ulcerated mass in the left colon. Histopathology and immunohistochemical results …

Spinal Pilomyxoid Astrocytoma In A 17-Month-Old Twin, Gul Emek Wymer, Chamyan Gabriel, Robert Bender, Susana Ferra

East Florida Division GME Research Day 2024

Introduction: A pilomyxoid astrocytoma is a rare type of brain tumor that primarily affects young children, typically arising in the hypothalamic-suprasellar region of the brain. Unlike pilocytic astrocytoma, PMA is characterized by a more aggressive clinical course and distinct histopathological features, including a monomorphic cell population, angiocentric arrangement, and a myxoid background.

Case presentation: A 17 months old patient with a history of twin to twin transfusion was brought to the hospital with a complaint of motor regression, compared to his twin. The CT and MRI images revealed an intradural intramedullary spinal mass. The mass tissue biopsy was sent to …

Standardization Of Operating Room (Or) Formalin Fixation Time Reporting In Breast Cancer Cases. An Institutional Experience., Cameron Summers, Astrid Sacasa, Nicole Sant Elia, Susana Ferra

East Florida Division GME Research Day 2024

Background: The current guidelines of the American society of Clinical Oncology (ASCO) and College of American Pathologists (CAP) regarding laboratory testing of estrogen receptor (ER), progesterone receptor (PR) and HER-2 in breast cancer have been in place since 2010. Optimal tissue handling requires a cold ischemic time of less than 1 hour and a formalin fixation time between 6 and 72 hours. In July 2023 HCA Westside hospital implemented a new Formalin Fixation Time documentation protocol. The data is presented quarterly at the Cancer Committee meeting.

Goal: To standardized the cold ischemic time and formalin fixation time reporting and measure …

Ossifying Fibroma And Central Giant Cell Granuloma, A Hybrid Tumor In The Maxilla, Jason Phung, Robert Bender, Susana Ferra

East Florida Division GME Research Day 2024

Introduction: Ossifying fibromas (OF) and central giant cell granulomas (CGCG) are benign lesions of the jaw. The presence of a hybrid lesion consisting of OF and CGCG is exceedingly rare.

Case summary: A 28-year-old male presented with complaints of nasal congestion and loud snoring worsening over six months. CT scan revealed a 2.2 x 1.5 x 1.2 cm radiolucent lesion involving the right maxillary sinus. During endoscopic sinus excision, a friable light tan and hemorrhagic lesion was seen occupying the right maxillary sinus with underlying bone destruction. Intraoperative pathology evaluation revealed no malignancy.

Results: Histologic examination revealed a biphasic …

Solitary Fibrous Tumor, Not Always The Pleura, Not Always Benign, Robert Bender, Susana Ferra

East Florida Division GME Research Day 2024

Introduction: Solitary Fibrous Tumor (SFT) is rare, especially in locations outside the pleura, and it can mimic benign mesenchymal tumors. Misdiagnosis, leading to inadequate treatment, can increase the risk of metastasis and recurrence. Dedifferentiated SFT (DD-SFT), is the most aggressive subtype.

Case Summary: A 45-year-old male presented with a rapidly growing, non-painful, palpable, exophytic right thigh mass. CT revealed an 8 x 7.4 x 7.0 cm heterogenous mass abutting the underlying muscle. His care team made a presumptive diagnosis of sarcoma, and referred him to a local oncologic surgeon who performed a radical excision and submitted the tumor to Pathology. …

The First Reported Case Of Relapsing Polychondritis Presenting With Invasive Squamous Cell Carcinoma, Navpreet Uppal, Lili Janasky, Maha Abdulla, Mohamad Saad

East Florida Division GME Research Day 2024

No abstract provided.

Cystic Neutrophilic Granulomatous Mastitis With Corynebacterium And Pseudomonas Species: A Comparison, Astrid Sacasa, Mohtashim Naeem, Susana Ferra

East Florida Division GME Research Day 2024

Introduction. Cystic neutrophilic granulomatous mastitis (CNGM) is an uncommon subtype of granulomatous mastitis (GM) affecting young to middle-aged parous women. Although there is no universally accepted diagnostic criteria, CNGM has a highly distinct histological pattern characterized by suppurative lipogranulomas composed of central lipid vacuoles rimmed by neutrophils with an outer cuff of epithelioid histiocytes.

Case 1: 42-year-old recently pregnant woman with a history of left breast mastitis and abscess treated with incision and drainage (I&D) six months prior, presented with contralateral right breast mastitis with abscess without improvement on oral antibiotics. Histologic examination revealed CNGM, with Corynebacterium identified on Gram …

Resolved Peristomal Erosive Papulonodular Dermatitis Mimicking Nevoid Hyperkeratosis Of The Nipple And Areola, Christa M. Tomc, Daniel A. Nguyen, Joseph S. Susa, Stephen E. Weis

HCA Healthcare Journal of Medicine

Introduction

Nevoid hyperkeratosis of the nipple and areola (NHKNA) is a rare cutaneous entity with a distinct clinical and histological presentation. The type II form of this condition can result from various dermatoses, such as irritant contact dermatitis. Erosive papulonodular dermatitis is a chronic irritant dermatitis that often occurs in areas of occlusion and maceration, such as peristomal skin. Pseudoverrucous papules and nodules are a variant of erosive papulonodular dermatitis and have a non-specific histologic pattern of reactive hyperplasia.

Case Presentation

We present a case of a patient with resolved peristomal erosive papulonodular dermatitis who presented status-post ileostomy reversal with …

An Exceedingly Rare Case Of Bilateral Synchronous Germ Cell Testicular Tumors Of Different Histological Types, Joseph Kim, Ray Page, Gregory Moses, Rod Carlo Columbres

North Texas GME Research Forum 2023

It is exceedingly rare to find a case of bilateral synchronous germ cell testicular tumors of different histological types, and there have been only a handful of cases because of a lack of connections through lymphatic or vascular pathways between the testes. Here we present a unique case of a 43-year-old man who initially presented to the primary care physician for increasing right testicular swelling. He had a testicular sonogram that showed a large right testicular mass as well as a 1.7 cm left testicular mass suspicious of malignancy. Pre-surgical laboratories showed PSA 0.97, alpha-fetoprotein 1875, quantitative hCG 2508, and …

Monitoring Concordance In The Management Of Transfusing Blood Components In Cirrhotic Patients For Paracentesis With Evidence-Based Guidelines, Joseph Kim, Gregory Moses

North Texas GME Research Forum 2023

Initiative to decrease unnecessary hemostatic agent transfusion in cirrhotic patients undergoing paracentesis: a resident-led approach quality improvement project to prevent transfusion overuse. Currently, there is no official guideline placed in the hospital for the administration of a hemostatic agent such as fresh frozen plasma in the setting of an elevated international normalized ratio, which paradoxically is an anticipated finding in cirrhotic patients. This process leads to unnecessarily prolonging the duration of the hospital course due to delays in performing the interventional procedures and interruptions in scheduling. The goal of this project is to educate and provide physicians with the most …

Lesion Size Inclusion On Dermatopathology Requisition Forms: A Quality Improvement Project, Christopher M. Wong, Henry Lim, Christian Scheufele, Daniel A. Nguyen, Ashleigh E. Hermann, Michael Carletti, Stephen Weis

North Texas GME Research Forum 2023

Introduction: Dermatopathology requisition forms (RFs) are a critical communication tool between dermatologists and dermatopathologists. Including detailed information on RFs improves the diagnostic accuracy of the consulting dermatopathologist. However, the diameter of the biopsied lesion is often omitted on RFs. This study aimed to increase the rate of reporting lesion diameters on RFs from an academic outpatient dermatology clinic to greater than 65% through education, reinforcement, and evaluation. Methods: This quality improvement project retrospectively and prospectively analyzed the inclusion rate of lesion diameters on dermatopathology RFs from a single institution. In Phase 1, data was collected from all skin biopsies performed …

Unsuspected Large B-Cell Lymphoma Diagnosed By Pleural Effusion Cytology After Chest Wall Trauma, Matthew Lee, Susana Ferra

East Florida Division GME Research Day 2023

No abstract available.

Cauda Equina Neuroendocrine Tumor (Paraganglioma), Cameron Summers-Powell, Tricia O'Brien, Susana Ferra

East Florida Division GME Research Day 2023

No abstract available.

Extra-Axial Desmoplastic/Nodular Medulloblastoma, Shh-Activated In Adult: A Case Report, Gul Wymer, Fatemeh Mousavi, Jennifer Barker

East Florida Division GME Research Day 2023

Introduction: Medulloblastoma (MB) is an embryonal central nervous system (CNS) tumor located in the posterior cranial fossa. Medulloblastoma is one of the most common malignant pediatric brain tumors, accounts for 25% of all pediatric intracranial tumors, but rare in adults; and constitute 0.4%-1% of adult primary brain tumors. The incidence of medulloblastomas in adults is approximately 0.5 per million per year and decreases with age with male predominance. Medulloblastomas classically appear as well-defined masses in the cerebellum that enhance both computed tomography (CT) of the head and brain magnetic resonance imaging (MRI) with gadolinium contrast. The clinical symptoms and signs …

Fumarate-Hydratase Deficient Leiomyoma – An Opportunity To Intervene, Gul Wymer, Brittany Nagel, Susana Ferra

East Florida Division GME Research Day 2023

No abstract available.

Microscopic Extraovarian Sex Cord Proliferations, Tricia O'Brien, Cameron Summers-Powell, Susana Ferra

East Florida Division GME Research Day 2023

No abstract available.

Comparing The Expression Of Er, Pr, Her-2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing?, Gul Wymer, Astrid Sacasa, Susana Ferra

East Florida Division GME Research Day 2023

BACKGROUND: The current College of American Pathologist (CAP) recommendation is that breast biomarkers Estrogen (ER), Progesterone (PR) and HER2 neu (Her2) testing be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors with the aim to identify patients that will benefit from hormonal treatment or anti-Her2 therapy. Repeat testing on a subsequent specimen is not usually indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need of adopting universal reflex re-testing of breast biomarkers in subsequent excision specimens. The rationale behind this study was based upon …

Congenital Giant Juvenile Xanthogranuloma, Let It Be, Michael Carletti, Daniel A. Nguyen, Joseph S. Susa, Stephen E. Weis

HCA Healthcare Journal of Medicine

Juvenile xanthogranuloma (JXG) is a rare type of non-Langerhans cell histiocytosis. JXGs are benign and have a self-limiting course generally lasting 6 months to 3 years, with some reported durations longer than 6 years. We present a rarer congenital giant variant, defined as lesions with a diameter larger than 2 cm. It is uncertain if the natural history of giant xanthogranulomas is similar to the usual JXG. We followed a 5-month-old patient with a 3.5 cm in diameter, histopathologically-confirmed, congenital, giant JXG located on the right side of her upper back. The patient was seen every 6 months for 2.5 …

Pleomorphic Dermal Sarcoma: A Clinical And Histopathologic Emulator Of Atypical Fibroxanthoma, But Different Biologic Behavior, Michael Carletti, Daniel A. Nguyen, Peter Malouf, Zachary Ingersoll, Gregory A. Hosler, Stephen E. Weis

HCA Healthcare Journal of Medicine

Pleomorphic dermal sarcoma (PDS) can clinically and histopathologically mimic atypical fibroxanthoma (AFX). However, it has a more aggressive clinical course with a higher recurrence rate and metastatic potential. This case presentation aims to report a rapidly-growing, exophytic, 4 cm tumor following a non-diagnostic shave biopsy 2 months prior and to highlight distinctive features between PDS and AFX needed to make the correct diagnosis. Like AFX, PDS occurs on the sun-damaged skin of the elderly, usually on the head and neck. Also, like AFX, PDS histopathologically consists of sheets or fascicles of epithelioid and/or spindle-shaped cells, often with multinucleation, pleomorphism, and …

Linear Cutaneous Lupus Erythematosus Following Blaschko’S Lines On The Scalp: Additional Cases And Review Of The Literature, Heather Reagin, Daniel A. Nguyen, Marc R. Lewin, Gregory A. Hosler, Eric Weisberg, Stephen E. Weis

HCA Healthcare Journal of Medicine

Alopecia of the scalp has various causes and presentations. However, linear alopecia is unusual and lupus erythematosus presenting as linear alopecia is exceedingly rare. To date, there have been 16 documented cases of linear alopecia diagnosed as chronic cutaneous lupus erythematosus occurring in a linear configuration following Blaschko's lines. We report 2 additional cases and review the clinical and histologic features along with treatment. This Blaschkoid linear variant of cutaneous lupus erythematosus has distinct clinical and histologic characteristics that set it apart from other causes of alopecia and from classic forms of cutaneous lupus. These distinct features include a linear …

Case Report: Disseminated Mucormycosis In An Ostensibly Immunocompetent Patient, Chad Froes, Matt Gellatly, Brian Watson

South Atlantic Division GME Research Day 2022

No abstract provided.

Ossifying Fibromyxoid Tumor: A Rare Subcutaneous Tumor, Karla C. Guerra, Luke Godwin, Chad Johnston, Maggie Noland, David Rowe

HCA Healthcare Journal of Medicine

The following case study demonstrates a 26-year-old male that presented to the dermatology clinic with an enlarging, raised skin nodule located on the left inferior lateral lower back. The patient reported it had persisted for two years, and he had not received prior treatment. He noted a family history of nonmelanoma skin cancer but had no other dermatological issues in the past. Physical examination revealed a pink, firm and well-circumscribed subcutaneous mass with a prominent follicular pore. It was assumed the lesion was an epidermal inclusion cyst, and surgical excision was performed. Histopathology revealed lobules of epithelioid cells with indistinct …

Goblet Cell Carcinoma Of The Appendix: A Case Report On Goblet Cell Carcinoid, Sheliza Kabani, Aubtin Saedi, Austin Lehr, Lina O'Brien

HCA Healthcare Journal of Medicine

Goblet cell carcinoid of the appendix is a rare neoplasm with histological features of both neuroendocrine and adenocarcinomas. The combination of its aggressive behavior, infrequent occurrence, and variable clinical presentation convolutes the management of this tumor. We report the case of a 75-year-old female presenting with acute appendicitis. A laparoscopic appendectomy was performed. The pathology report showed goblet cell carcinoid at the base of the appendix with involvement of the proximal surgical margins. At her postoperative visit, the patient’s pathology report and options for management were reviewed, and the patient agreed to proceed with a right hemicolectomy 8-10 weeks after …

Neuroendocrine Tumor Of The Gallbladder, A Rare Incidental Finding, Alvaro Frometa, Yasna Chaudhary, Omar Ansari, Nigel Jagoo, Iqbal Kapadia

HCA Healthcare Journal of Medicine

Background: Neuroendocrine tumors are a rare finding in the gallbladder. The incidence of this entity in the gallbladder is roughly 1.13 cases per 100,000 in the US, with a steady increase in the last decade. Gallbladder neuroendocrine tumors are generally asymptomatic; the majority of cases have been reported as incidental findings in specimens, resected due to secondary symptomatology, such as chronic cholecystitis. Treatment strategies are limited, in part due to the often advanced stage in which this disease presents. Furthermore, there is a restricted utility of diagnostic tools for early detection; these factors contribute to the poor prognosis of this …

A Case Series Of Hyponatremia And Management In Hospitalized Patients, Jake N. Cho, Rebecca Ong, Izuchukwu Nwakoby

Nephrology

No abstract provided.

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study And Treatment In A Pediatric Patient, Brian Derner Dpm, Kristine Hoffman, Amy Storfa Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Juvenile xanthogranulomas (JXG) are a benign histiocytic cell proliferative disorder in early childhood. They most commonly present within the first two years of life with papular or nodular changes to the skin on the head, neck or upper trunk. Xanthogranulomas are mostly self-limiting, can be singular or multiple, and rarely can infer a systemic disease process1. The purpose of this study was to publish a unique finding of an extra-tendinous solitary mass in an otherwise healthy 17-year old, with surgical and medical treatment after diagnosis.