Histopathology EQA Scheme Case Discussion Round
Join the South East England General Histopathology EQA Scheme Case Discussion Round meeting on Monday, 24th July 2023, starting at 12:00 pm. Dive into insightful discussions and stay updated on the latest developments in histopathology.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
South East England General Histopathology EQA Scheme Case Discussion Round v Monday 24thJuly, 2023 THANK YOU FOR WAITING The meeting will start at 12:00pm
Meeting Etiquette 4 3 2 1 Mute your mic if you re not speaking Wait for the Chair person to call on you before you unmute your mic Use the raise hand Or chat feature to raise questions or share ideas If your camera is on, everyone can see you Remember Everyone can see your chat comments 6
Agenda 1. Welcome & Introduction of Scheme Staff 2. Meeting Terms of Reference 3. Case and Preliminary Score Review a) Case 889-898 b) Educational Cases 899 - 900 4. Questions / comments
This meeting is held between the end of case consultation and results being issued and now replaces the additional final week of the case consultation. This meeting is an educational exercise; an opportunity to explain the reasons behind scoring and merging or why cases were excluded. For clarity, this is not an opportunity to alter merging decisions, as participants have that opportunity during the Case Consultation period. An additional CPD point will be awarded to those who attend, and it will be added to the annual certificate. Please note you have to stay for >50% of the meeting to gain this point (attendance times are monitored automatically by Teams) We always welcome any feedback good or bad you may have about today.
CaseConsultation 156 responses received for round v 95 responses received for consultation 60.90% QUORATE Thank-you for submitting responses and consultation on time you have made completion of this round much easier for all Basic Rules regarding Case Consultation and Merging Diagnostic categories: If you are exempt from a category, your consultation response to that case is not counted Each case must have received a consultation response from at least 50% of those that answered it For a merge to be automatically accepted, more than 50% of consultation respondents must agree Between 40-50% agreement, the merge will be accepted only with the agreement of the Organiser (i.e. clinically valid). The consensus CAN be over-ridden if there are clinically valid reasons for doing so. These are recorded, and reviewed at the AMR.
Case 889 Miscellaneous Specimen: Fatty tissue Submitted Diagnosis: Spindle Cell Lipoma Submitted Clinical Macro Immuno Image link Preliminary Results Final Merge Results M69. Two back lipomas (one over the right, another over the left side of the back) Slightly irregular / disrupted fatty tissue altogether measuring 90mm long, up to 30mm wide and 25mm thick. CD34 positive Click here to view digital image 1. Spindle cell lipoma 9.74 2. Cellular angiolipoma 0.06 3. Atypical lipomatous tumour/well differentiated 0.06 liposarcoma 4. Elastofibroma 0.10 5. Lipomatous neurofibroma 0.03 67.37% agreed not to merge any diagnoses It appears to contain 3 separate nodules, the smaller measures 21mm, medium 24mm and the larger 45x30x25mm.
Case 890 Respiratory Specimen: Bronchial biopsy Submitted Diagnosis: Low grade mucoepidermoid carcinoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results M46. Left lower lobe opacity on CT scan. Seven pieces of pale brown tissue ranging from 1-3 mm. Positive for CK7 (strong) and p63 (focal). Negative for TTF1, Synaptophysin, Chromogranin, CD56, CK20. Click here to view digital image 1. Mucoepidermoid carcinoma 8.21 (+/- low grade) 2. PECOMA 0.04 3. Non small cell CA with clear cell 0.26 features / SCC 4. Bronchial gland adenoma 1.23 5. Adenoid cystic carcinoma 0.07 6. Other second opinion 0.01 7. Pleomorphic adenoma 0.07 8. Acinic cell carcinoma 0.01 9. Salivary gland type tumour 0.03 10. Large cell carcinoma 0.07 44.94% of participants agreed not to merge any diagnoses. Visible endobronchial abnormality. Ki67 shows approx 1% positive cells.
Case 891 Endocrine Specimen: Parathyroid Gland Submitted Diagnosis: Parathyroid Adenoma (cystic with change) Clinical Macro Immuno Image link Preliminary Results Final Merge Results M70. Parathyroid Gland. 69.15% of participants agreed to merge 1, 2, 3 A gelatinous and partially tan tissue weighing 4.8g and measuring 38 x 20 x 10mm. N/A Click here to view digital image 1. Parathyroid adenoma 8.80 2. Adenoma 0.26 3. Chief cell adenoma 0.13 4. Parathyroid hyperplasia 0.44 5. Parathyroid cyst 0.13 6. Atypical parathyroid adenoma 0.18 7. Renal cell carcinoma 0.01 8. Heterotropic benign thyroid 0.03
Case 892 Gynae Specimen: Ovary Submitted Diagnosis: Consistent with metastatic breast cancer with neuroendocrine differentiation. Clinical Macro Immuno Image link Preliminary Results Final Merge Results 50.56% of participants agreed to merge 1, 3 F44. History of breast cancer. Prophylactic BSO Two ovaries and attached adnexa received in same pot. ER+, Chromogranin+ Synaptophysin+, CK7+ Click here to view digital image 1. Neuroendocrine carcinoma 6.47 (no grade specified) (primary/met) 2. Carcinoma 2.07 (Neuroendocrine NOT mentioned) 3. Low grade Neuroendocrine / Carcinoid 1.40 4. Metastatic small cell carcinoma - PDNEC 0.07 No gross abnormality. Calretinin-, WT1-, CK20-, TTF1-, Inhibin-
Case 893 Lymphoreticular Specimen: Lymph node Submitted Diagnosis: Peripheral T-Cell Lymphoma NOS (WHO2017) Clinical Macro Immuno Image link Preliminary Results Final Merge Results 52.38% of participants agreed to merge 1,2 M42. Left inguinal enlarged lymph node. Fever & sweats. Multiple enlarged lymph nodes present. 35 x 20 x 13mm. Firm grey nodule Positive: BCL- 2, MUM -1, ICOS, CD3, CD5 & CD4. Some positive CD8, TIA+ granzyme B Negative: CD56, CD56, CD57, CD30, CD15, CD21, CD23, CD10, BCL-6, EMA, ACK-1, CD20, AE1/AE3 Click here to view digital image 1. Peripheral T Cell Lymphoma NOS 8.16 2. Angioimmunoblastic T Cell Lymphoma 1.18 3. DLCBCL 0.14 4. Lymphoma / NHL 0.28 5. TCL - Sezary Syndrome 0.14 6. Nodal anaplastic large cell lymphoma 0.10
Case 894 Breast Specimen: Breast Submitted Diagnosis: Giant Fibroadenoma Clinical Macro Immun o Image link Preliminary Results Final Merge Results F20. Breast nodule Well circumscribed nodule 90x60mm. N/A Click here to view digital image 1. Juvenile fibroadenoma 0.62 2. Fibroadenoma with pseudoangiomatous 1.63 hyperplasia 3. PASH 2.09 4. Fibroadenoma 4.70 5. Hamartoma and PASH 0.50 6. Hamartoma 0.21 7. Benign phyllodes tumour 0.01 8. Hamartoma with gynaecomastia-like 0.07 changes 9. Cellular fibroadenoma 0.13 10. Diabetic mastopathy 0.02 Case excluded Consensus cannot be reached unless 3 is included
Case 895 GU Specimen: Kidney Submitted Diagnosis: Angiomyolipoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results F64.Biopsy proven oncocytic tumour. Right lower pale partial nephrectomy. Partial nephrectomy, weighing 26g, measuring 36x35x34mm polypoid subcapsular tumour 36x33mm. SMA, Melan A positive Click here to view digital image 1. Angiomyolipoma 9.88 2. PEComa 0.03 3. Angiomyelolipoma 0.07 4. Adrenal cortical carcinoma 0.01 CLINCAL OVER-RIDE CK7, AE1/3, PAX8, CD17, HMB45 negative Angiomyolipoma is part of the PEComa group and therefore no clinical differences. merge 1 & 2 will be merged
Case 896 GI Specimen: Polyp in sigmoid Submitted Diagnosis: Granular Cell Tumour Clinical Macro Immuno Image link Preliminary Results Final Merge Results M41. FHx of CRC. 3mm polyp in sigmoid (hot snared) Piece of tissue measuring 5mm. S100 positive, SMA, desmin, DOG1, CD117 and CD34 Negative, Ki-67 less than 1% Click here to view digital image 1. Granular Cell Tumour 7.19 2. (Granular cell) Schwannoma 0.55 3. Mucosal Schwann cell hamartoma 0.04 4. Mucosal neuroma 0.03 5. Rhabdomyoma 0.06 6. Ganglioneuroma 1.69 7. Neurofibroma 0.28 8. Neuroma 0.09 9. Granulosa cell tumour 0.06 45.74% agreed to merge 1,2
Case 897 Skin Specimen: Skin excision Submitted Diagnosis: Benign pilomatrixoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results M65. Excision of lesion forehead/scalp EOS 23 x 13 x 8mm bearing a pale firm nodule 14mm. Underlying cyst present 1mm diameter with off white contents. N/A Click here to view digital image 1. Pilomatrixoma 10.00 NA
Case 898 GI Specimen: Hemicolectomy specimen Submitted Diagnosis: Crohn's stricture and several granulomas Clinical Macro Immuno Image link Preliminary Results Final Merge Results M30. Limited right hemicolectomy performed. Right hemicolectom y specimen. Haemorrhagic ileal stump and ascending colon. N/A Click here to view digital image 1. Granulomatous inflammation 3.67 (non- infectious - Crohns/sarcoid/ post-op) 2. Schistosomiasis / Schistosoma 3.03 3. (FB) Granulomatous inflammation NOS 1.35 4. Granulomatous inflammation - parasites 0.58 5. Granulomatous inflammation both infectious 1.36 and non-infectious aetiologies mentioned Case Excluded Consensus cannot be reached unless 1 & 2 are included and merged.
Case 899 Miscellaneous (EDUCATIONAL) Specimen: Gum Tissue Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis M44. Lesion upper right molars, resorption of roots on xray, cystic lesion right maxillary antrum ?SCC Multiple soft tissue fragments N/A Click here to view digital image 1. Ameloblastoma x 128 2. Adenomatoid odontogenic tumour x 4 3. Adamantinoma x 3 4. ADENOMATOID TUMOUR x 2 5. KERATOAMELOBLASTOMA x 2 Plexiform Ameloblastoma
Case 900 Skin (EDUCATIONAL) Specimen: Polyp Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis M92. Fibroepithelial polyp on right side of chest, excision. Specimen consists of pale papilloma measuring 25 x 20 to a depth of 5mm. Positive for BER- EP4. Scattered positive cells for CK20 are seen in the anastomosing strands and cords of basaloid cells. Click here to view digital image 1. Fibroepithelioma of Pinkus x 52 2. Fibroepithelioma of Pinkus x 31 +/- BCC 3. Basal cell carcinoma x 17 4. TRICHOBLASTOMA x 15 5. Trichoepithelioma x 8 Basel Cell Carcinoma Fibroepitheliomatous (fibroepithelioma of pinkus) and nodular types. Point of attachment measures 12mm in diameter. No unusual lesions are identified on the surface. Two TS's taken in one cassette.
4. Questions Comments Suggestions Feedback Thank you for attending. This presentation can be found on the EQA website from next week.
