THANK YOU FOR WAITING

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This meeting on Wednesday, 27th March 2024, focuses on case discussions and reviews within the South East England General Histopathology EQA Scheme. Participants will engage in educational exercises, review case consultations, and adhere to meeting etiquette guidelines. The session offers an opportunity for scoring explanations and feedback sharing. Attendees can earn CPD points by participating actively.

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South East England General Histopathology EQA Scheme Case Discussion Round x Wednesday 27thMarch, 2024 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 914-924 b) Educational Cases 925-926 4. Questions / comments

2. Meeting Terms of Reference

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.

3. Round x Review

CaseConsultation 152 responses received for round x 85 responses received for consultation 56% 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 914 Endocrine Specimen: Lymph node Submitted Diagnosis: Paraganglioma Clinical Macro Immuno Image link Preliminary Results Final Merge Results Submitted M28. 2.5cm node para aortic at level of IMA ?Lymphoma ?Testicular ?Benign Grey soft nodule almost spherical 25mm diameter Diffuse strong expression for synaptophysin & Chromogranin A. Click here to view digital image 1. Paraganglioma / pheochromocytoma 9.73 2. NET / Carcinoid 0.27 90% agreed NO MERGES Some reaction for S100. MIB approx 1%. AE1/AE3 negative.

Case 915 Respiratory Specimen: Lobe Nodule Submitted Diagnosis: MALToma (extra-nodal marginal zone lymphoma of mucosa-associated lymphoid tissue) Clinical Macro Immuno Image link Preliminary Results Final Merge Results F91. PET positive left lower lobe nodule and bilateral PET negative small pulmonary nodules. Left lower lobe wedge contains a wedge excision measuring 106 x 94 x 25mm with a nodule at 21 x 19 x 17mm. 8mm from the stapled margin. Positive for CD20, CD79a, bcl-2 and lgM. Reversal of the normal kappa: lambda ratio. Click here to view digital image 1. MALT Lymphoma / Low Grade B Cell 8.86 Lymphoma 2. Lymphoplasmacytic lymphoma 0.68 / Waldenstroms 3. Follicular Lymphoma 0.10 4. Plasmacytoma 0.07 5. CLL / Small lymphocytic lymphoma 0.14 6. Reactive pseudolymphoma 0.01 7. Lymphoproliferative lesion 0.08 8. Hodgkin lymphoma (nodule lymphocyte 0.07 predominant) 36-74% agreed to merges of 1&2, 1&9 or 1,2 and 9 Therefore we will merge 1, 2 & 9 Cells are negative for CD10, bcl-6 and cyclin-D1. Scattered CD3 and CD5 positive cells. The ki67 proliferation index is low. Frozen section suggestive of benign disease ??lymphoma therefore no further pulmonary resection. 35mm away from the nodule is further nodule 12 x 5 x 5 mm it is 5 mm from the stapled line.

Case 916 Miscellaneous Specimen: Subcutaneous lump Submitted Diagnosis: Deposit of endometriosis/endometrioma. Clinical Macro Immuno Image link Preliminary Results Final Merge Results No merges F42. Subcutaneous lump - fascia of right iliac fossa Piece of fibro fatty tissue 21 x 20 x 11mm. None Provided Click here to view digital image 1. Endometriosis 10.0

Case 917 Breast Specimen: Breast Submitted Diagnosis: Tubular Adenoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results 51% agreed NO MERGES F28. Left breast mass excised due to size. Nodular white tissue measuring 15x30x40mm. None Provided Click here to view digital image 1. Tubular Adenoma 9.12 2. Adenomyoepithelioma 0.48 3. (microglandular) Adenosis 0.33 4. Fibroadenoma 0.07 Firm white cut surface

Case 918 Lymphoreticular Specimen: Bowel Submitted Diagnosis: Diffuse large B cell lymphoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results 57% agreed NO MERGES M59. Small bowel obstruction 52mm lesion invading bowel wall and obstructing lumen Positive:CD7 9a, BCl-2, MUM1, PAX- 5 Negative: CD3, CD5, CD10, CD21, CD23, Cyclin D1. MIB-85- 95% Click here to view digital image 1. High Grade B Cell Lymphoma / DLBCL 9.37 2. Hodgkins lymphoma (nodular lymphocyte 0.14 predominant) 3. Marginal zone lymphoma 0.07 4. Plasmacytoid lymphoma 0.14 5. Lymphoma 0.22 6. Burkitts lymphoma 0.05 7. Blastoid lymphoma 0.01

Case 919 Gynae Specimen: Vulva Submitted Diagnosis: Vulval mucinous and ciliated cyst Clinical Macro Immuno Image link Preliminary Results Final Merge Results F38. Left vulval cyst. Cyst measuring 13x10x5mm; contents of a tan gel-like substance. None provided Click here to view digital image 1. Bartholins cyst 9.63 2. Hidrocystoma 0.36 3. Hidradenoma papilliferum cystically dilated 0.01 60% agreed to merge 1, 2 & 3.

Case 920 GU Specimen: Kidney Submitted Diagnosis: Oncocytoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results F47. Left renal mass? RCC. Laparoscopic left radical nephrectomy. History of breast cancer. Kidney measures 140 x 80 x 80mm. Lower pole of kidney contains a large bulging circumscribed tumour, 80 x 60 x60mm. The cut surface has a mahogany brown colour and a central white scar. CD117 and EMA positive. Click here to view digital image 1. Oncocytoma 9.72 2. Renal Cell Carcinoma 0.21 42% agreed to merge 1 & 3 CK7 and CD10 negative.

Case 921 GI Specimen: Polyp Submitted Diagnosis: Hamartomatous (Peutz-Jegher-type) polyp Clinical Macro Immuno Image link Preliminary Results Final Merge Results F66. D2 polyp removed. Polyp measuring 20mm. Normal mucosa at base. None provided Click here to view digital image 1. Peutz Jeghers polyp 5.77 2. Adenoma (dysplasia) 2.55 3. Hyperplastic polyp 0.85 4. Hamartomatous polyp 0.66 5. Sessile serrated lesion (without dysplasia) 0.10 6. Benign epithelial proliferation ? Gastric 0.07 metaplasia 72% agreed to merge 1&4 However, CONSENSUS ONLY REACHES 64% SO CASE IS EXCLUDED FROM SCORING

Case 922 Skin Specimen: Mole Submitted Diagnosis: Dermatofibroma Clinical Macro Immun o Image link Preliminary Results Final Merge Results M29. Mole? Blue naevus? Malignant melanoma. An irregular ellipse of skin 13 x 5 x 7mm deep. Towards one edge, there is a flat grey lesion measuring 4 x 3mm. Melan A negative. Click here to view digital image 1. Blue Naevus 0.20 2. Dermatofibroma / Fibrous Histiocytoma 9.61 3. AFX (Atypical Fibroxanthoma) 0.07 4. Giant cell tumour of skin 0.02 5. Hobnail haemangioma 0.07 6. Juvenile Xanthogranuloma 0.03 61% agreed to NO MERGES Perls stain positive. Left posterior, inner and upper thigh. The lesion is located approximately 1mm away from the nearest peripheral margin. Slicing reveals an orange cut surface.

Case 923 Miscellaneous Specimen: Neck Submitted Diagnosis: Acinic cell carcinoma, metastatic DPAS positive granules Clinical Macro Immuno Image link Preliminary Results Final Merge Results F81. Lump on neck. Previous surgery for salivary gland tumour. Ellipse of skin containing subcutaneous nodule 10x6x35mm. DPAS positive granules Click here to view digital image 1. Acinic Cell carcinoma 9.41 2. Granular Cell Tumour 0.16 3. Myoepithelioma 0.02 4. Hibernoma 0.13 5. Acinic cell adenoma 0.07 6. Sebaceous gland adenoma 0.07 7. Oncocytoma 0.07 8. Salivary gland tumour 0.07 80% agreed to NO MERGES

Case 924 Miscellaneous DIGITAL ONLY Specimen: Tongue Biopsy Submitted Diagnosis: Favour a benign vascular lesion Clinical Macro Immuno Image link Preliminary Results Final Merge Results M65. Ventral mid tongue surface chronic ulcer. Tongue bx. Two fragments of tissue 1mm x 4mm None provided Click here to view digital image 1. Haemangioma 3.11 2. (pseudo)epithelial Hyperplasia 4.20 (incl keratosis)+/- haemangioma 3. Dyplasia 0.13 4. Ulcer (with Vascular Base) 0.43 5. SCC / suspicious for verrucous carcinoma 0.39 6. (Partly organised) granulation tissue 0.26 / reparative process 7. Pyogenic granuloma 0.95 8. Vascular proliferation needs IHC 0.07 ? Kaposi s 9. LCH 0.05 10. Arteriovenous malformation 0.41 62% agreed to merge 1 & 2, However, this still falls short (73%) of the 75% required to score this case. Therefore, THIS CASE IS EXCLUDED FROM SCORING

Case 925 EDUCATIONAL Specimen: Penile biopsy Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis M53.Penile lesion gradually increasing in size. Piece of grey tan mucosal tissue measuring 7x5mm and 2mm in depth. There is a slightly raised discoloured area towards one edge measuring 4 x 3mm bisected and all embedded. Immunochemistry demonstrates that the histiocytoid cells are positive for S-100 and CD1a with focal CD68. Click here to view digital image 1. Langerhans cell histiocytosis x 143 2. Histiocytosis X/ LCH x 3 3. Eosinophilic granuloma x 3 4. Eosinophilic granuloma(Langerhans histiocytoma) 5. Langerhans cell histiocytosis (ideally needs confirmatory langerin IHC or EM) Langerhans Cell Histiocytosis They are negative for melanocyte markers (Melan-A, HMB-45 and SOX10), also negative for CD30 and pan cytokeratin (MNF116).

Case 926 EDUCATIONAL Specimen: Mediastinal node Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis M76. CABG. Specimen sent as a mediastinal node Fatty tissue with calcified presumed lymph node 20x15x5mm. Trisected and all embedded. Positive for AE1/AE3, CK7, CK5, P63, PAX8 and SDH-B. Negative for CD45, S100, chromogranin, synaptophysin, GATA3, CD5,CD117,CK20, carbonic anhydrase IX and CD10, RCC. Very sparse staining with CD5, TdT, CD1a and CD99 within the nodules. Click here to view digital image 1. Thymoma x 48 2. Thymoma, B3 x 26 3. Thymic carcinoma x 19 4. Metastatic renal cell carcinoma x 17 5. Metastasis renal cell cancer x 5 B3 Thymoma, Masaoka 2b (no tumour encapsulation) and pT1a