Previous Pathology Case Challenges

A 9-year-old boy is found to have abdominal distention and an abdominal mass and undergoes a right lobectomy of the liver. A 12.5 cm heterogeneous hemorrhagic, soft solid and focally cystic mass is identified in the liver. The tumor appears fairly well circumscribed, and focally is associated with rupture of the capsular surface. The tumor is located 0.3 cm from the nearest surgical margin. The surrounding hepatic parenchyma appears congested.

A 63-year-old man presents to the emergency room with a ruptured spleen and an emergency splenectomy was done. He carries a diagnosis of a myeloproliferative neoplasm, for the past 2 years and has progressively become pancytopenic. His peripheral blood smear shows a leuko-erythroblastic picture.

A 65-year-old man presents with a painful left pelvic mass of four months duration. The pain is intermittent, is noted at rest and becomes worst at night. Radiographs reveal an 8.4 cm intramedullary lucent lesion of the left pelvic bone that contains irregular punctate opacities. The lesion extends through the cortex that demonstrates prominent adjacent periosteal reaction, and involves soft tissue. There is no history of previous radiation to this area. The lesion is resected and represented by the enclosed slide.

A 57-year-old man with no significant past medical history presents to a neurosurgeon for intractable lower back pain. Radiographic studies document a lytic mass within the sacrum compressing surrounding nerves. An image guided needle biopsy is performed and surgical excision is subsequently scheduled. A 5.8 centimeter soft, multilobulated variegated gray to gray-tan mass with a gelatinous texture was received for gross examination. Samples are prepared for routine histologic examination and electron microscopy. Tumor cells show staining for periodic acid Schiff staining which digests upon diastase treatment and are immunoreactive for S-100, pan-cytokeratin, EMA, and brachyury.