final analysis of nndeqa 004 (may 2013 tsl...
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CONSULTANTSFibroadenoma (with ductal epithelial hyperplasia/complex)Fibroadenoma with atypical epithelial hyperplasiaBenign Phyllodes (with epithelial hyperplasia)Benign proliferative breast lesion with usual type ductal hyperplasia and FEATubular carcinomaWell differrentiated invasive ductal carcinoma (tubular, sclerosing adenosis)
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Final analysis of NNDEQA 004 (May 2013 TSL workshops)
1) 70 year old female with focal irregularity in the right breast.
CONSUL TANTSFat necrosis (with organising thrombus/foreign body granuloma/surgical site reaction)Granulomatous with vasculitis
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RESIDENTSFat n_ecrosis(traumatic)Chronic granulomatous mastitisDuct ectasiafibrocystic change with fat necrosis
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DIAGNOSIS: Haematoma and traumatic fat necrosis 32
2) Left breast lesion in adult female
RESIDENTSFibroadenoma (with ductal hyperplasia/epitheliosis/fibrocystic change/cystic mastopathy) 14Benign phyllodes tumour 3Fibrocystic changes 1Tubular carcinoma 1
DIAGNOSIS: Fibroadenoma 32
3) Right breast cyst 66 year old female
CONSULTANTSInvasive ductal carcinoma85 - (high grade) DCIS (with neuroendocrine features)Papillary carcinomaFirbocystic changes with atypical or usual ductal hyperplasiaAtypical ductal hyperplasiaUsual duct hyperplasia
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RESIDENTSInvasive ductal carcinomaAtypical ductal hyperplasia(lnvasive) papillary carcinomaSclerosing aden os is with florid ductal hyperplasiaAdenomyoepitheliomaMetastatic ovarian tumour
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DIAGNOSIS: Invasive ductal or papillary carcinoma accepted .32
CONSUL TANTS(chronic) Granulomatous mastitisGranulomatous mastitis probably TB, exclude fungal infectionGranuloma exclude sarcoid
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4) Left breast lesion adult female.
RESIDENTSChr.onic granulomatous mastitisChronic granulomatous inflammation (most likely TB)Invasive ductal carcinomaTuberculous mastitis (AFB positive)
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DIAGNOSIS: Granulomatous mastitis (necessity to exclude TB/fungi accepted 32
5) Nipple abnormalities in a 50 year old female - nipple excised
CONSULTANTSDuctal/nipple/central papilloma (and florid papillomatosis)Invasive ductal carcinoma (with pagetoid spread/background papillomatosis)Duct ectasiaLobular carcinomaSubareolar sclerosing duct hyperplasiaPaget's disease of the nippleMicropapillary carcinoma
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RESIDENTSDuct ectasia (+columnar cell metaplasia)Invasive ductal carcinomaPaget's diseaseIntraductal papillomaNipple adenomaNo answerSclerosing lymphocytic mastitisInvasive lobular carcinomaPapillary cystadenomaNeurofibroma (dermal)
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DIAGNOSIS: Nipple involvement by infiltrating lobular carcinoma 32
CONSULTANTSChronic mastitis (fungal)Duct obstruction/duct ectasia/periductal mastitis (with abscess)Acute on chronic mastitis (with suppuration)Focus of malignancy surrounded by abscessFibroadenoma with cystic mastopathy
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6) Right breast lesion in adult female
RESIDENTSDuct ectasia/periductal mastitisDiabetic mastopathy/lymphocytic mastitisAcute on chronic mastitisChronic granulomatous inflammation (with fat necrosis)Breast abscessMixed invasive ductal and invasive lobular carcinomaChronic mastitis with sclerosing adenosisFibrocystic disease with acute on chronic mastitis
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DIAGNOSIS: Acute/chronic mastitis with periductal/lobular pattern and suppuration 32
7) Right breast lump in adult female
CONSULTANTS(Intermediate grade/micropapillary) DCISInvasive ductal carcinomaComedo carcinomaNeurofibromaAtypical ductal hyperplasia (micropapillary variant)Papillary carcinoma
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RESIDENTS'DCIS (papillary/micropaplllaryj/intraductal carcinoma 15Micropapillary carcinoma 2Intracystic papillary carcinoma 1Comedo carcinoma 1
DIAGNOSIS:High-grade DCIS with micropapillary pattern. No invasive tumour seen 32
8) Left breast lump in adult female.CONSULTANTS(complicated) fibrocystic disease (with ductal epithelial hyperplasia/periductal inflamm) 9Sclerosing adenosis (with cystic mastopathy) 1Apocrine metaplasia 1Ruptured galactocoele 1Mucin filled ducts FEA, CCC 1
RESIDENTSFibrocystic change (apocrine metaplasia/with usual duct hyperplasia)Apocrine adenosis (variant of sclerosing adenosis)/sclerosing adenosisRadial sclerosing lesionMicroglandular adenosisComplex fibroadenomaDIAGNOSIS: Focus of fibrocystic change with apocrine metaplasia
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CONSULTANTSIntraduct papilloma (with epithelial hyperplasia)PASHHormonal atrophy81unt duct aden os is82, benignDuctal hyperplasia84Sclerosinq aden os isMicroglandular hyperplasiaTubular adenomaLobular hyperplasia with ductal extension
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9) 44 year old woman, ? Fibroadenoma
RESIDENTSLobular neoplasia/Atypicallobular hyperplasiallobular carcinoma in-situInvasive (tubulo) lobular carcinomaDCISTubular adenomaStromal fibrosis and squamous metaplasiaIntraductal papillomaNo answer82, benignFlat epithelial atypiaFibrocystic disease (non-proliferative variant)PASHSclerosing adenosisMild intraductal hyperplasia
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DIAGNOSIS: No definte lesion? Atrophic/filSrotic breast tissue 32
10) Right breast lump in a 68 year old woman.
CONSULTANTSInvasive lobular carcinoma (85, malignant) .Invasive ductal carcinoma (85, malignant)(neuroendocrine differentiation)Intraductal carcinoma
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RESIDENTSInvasive ductal carcinoma (85b)Invasive lobular carcinomaneuroendocrine carcinomaMixed invasive lobular and ductal carcinomaSquamous cell carcinoma85, malignant
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DIAGNOSIS: Mixed invasive ductal and invasive lobular carcinoma 32
CONSULTANTSDCIS (apocrine, high grade)Jintraductal carcinomaInvasive ductal carcinoma (with high grade DCIS)Medullary carcinomaChoriocarcinomaApocrine carcinoma
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11) 57 year old woman with malignant calcification on x-ray/mammography.
RESIDENTSDCIS (high grade, apocrine, choriocarcinomatous features)Jintraductal carcinomaInvasive ductal carcinoma (85b, from high grade DCIS)Atypical ductal hyperplasiaLCISNo answerMastitisMedullary carcinoma
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DIAGNOSIS: High grade DCIS 32
12) 29 year old woman, 26 weeks pregnant? Fibroadenoma
CONSUL TANTSLactating adenomaJadenosis (82)83 - suspicious, probably benign (lactating adenosis)columnar cell change with atypia
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RESIDENTSLactating adenomaJadenosis (82) 19
DIAGNOSIS: Lactating adenoma/adenosis 32
13) Female 59 years, left micrododectomy/duct excision for bleeding left nipplewith ulcerated surface
CONSULTANTSPaget's disease with ductal carcinomaNipple adenomaDuct/intraductal papillomaDuct ectasia with epithelial hyperplasiaNo answer
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RESIDENTSIntraductal/duct papilloma 7Paget's disease with ductal carcinoma 6Usual duct hyperplasia 1Periductal mastitis 1No answer 2Nipple papillomatosis 1Intraductal papilloma with microinvasive ductal carcinoma 1
DIAGNOSIS: Benign skin adnexal tumour - Nevus sebaceous/syringocystadenoma 32
14) Right breast biopsy from? Recurrence after radiotherapy to treat previousneoplastic lesion. Female 69 years. MACROSCOPY: Skin ellipse 65 x 37 mmwith underlying fibrofatty tissue 52 x 35 x 26 mm. 2 skin lesions 10 and 4 mm inmaximum dimension respectively are separated by 3 mm of normal tissue.
CONSULTANTSAngiosarcomallymphangiosarcomaKaposi sarcomaRadiotherapy effectMalignant haemangiopericytomaMetaplastic carcinoma/angiosarcoma
RESIDENTSAngiosarcomaKaposi sarcomaLow grade stromal/soft tissue sarcoma (?fibrosarcoma)Stromal sarcoma/angiosarcomaHaemangiopericytomaMetaplastic carcinomaNo answerMalignant spindle cell tumour
DIAGNOSIS: Angiosarcoma
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15) Left breast lump in a 47 year old female. Clinically and radiologically benign.Core biopsy - B3 ? Phyllodes, therefore excised with cuff of normal tissue around.MACROSCOPY: Tissue fragments 29 x 26 x 19 mm and 7 g.
CONSULTANTS(Giant) fibroadenomaSclerosing adenosisTubular adenoma _Cellular fibroadenomaBenign Phyllodes tumourSclerosing adenoma with atypiaMicroglandular adenosis
RESIDENTS
Fibroadenoma (complex, fibroadenomatoid hyperplasia)Sclerosing aden os isFibrocystic diseaseTubular adenomaBenign PhyllodesJuvenile fibroadenoma
DIAGNOSIS: Cellular or juvenile fibroadenoma
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CONSUL TANTSFollicular lymphoma (no grade stated)No answerFollicular lymphoma grade 2ReactiveHodgkin's lymphoma
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16) Submental lymph node from female 63 years. ? LymphadenitisIMMUNOHISTOCHEMISTRY: Lesional cells express CD20, CD10 and Bcl-2. Presence ofneoplastic FDC meshwork confirmed with CD23.
RESIDENTSFollicular (centre cell) lymphoma (no grade stated)No answerAngioimmunoblastic lymphadenopathyFollicular carcinoma
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DIAGNOSIS: WHO grade 1-2 follicular non-Hodgkin's 8-ceU lymphoma 32
17) Axillary lymphadenopathy 32 year old male.IMMUNOHISTOCHEMISTRY: Tumour cells express CD30, CD15 and EBV-LMP1 but arenegative with CD45.
CONSULTANTSHodgkin's lymphoma (nodular sclerosis, classical, lymphocyte rich)No answer
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RESIDENTSHodgkin's lymphoma (nodular sclerosis, classical, mixed cellularity, lymphocyte rich) 12No answer 5Diffuse B-ceillymphoma with sclerosis 2
DIAGNOSIS: Nodular sclerosing classical Hodgkin's lymphoma 3218) Left axillary lymph: nodes biopsy in a 62 year old female with mediastinal mass andsuperior vena cava obstruction. ? LymphomaIMMUNOHISTOCHEMISTRY: Not yet done
CONSULTANTSSinus hyperplasia/sinusoidal histiocytosis (+paracortical hyperplasia)No answerMetastatic carcinomaLow grade lymphomaReactive hyperplasia
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RESIDENTSNo answerSinus histiocytosis (reactive hyperplasia)Metastatic carcinomaNon-Hodgkin's lymphoma (low grade)Mediastinal (thymic) large B-ceillymphomaChronic lymphadenitisFibrohistiocytosis
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DIAGNOSIS: Sinus histiocytosis - reactive lymphadenopathy 32
CONSULTANTS(Reactive) follicular hyperplasiaNo answerNon-Hodgkin's lymphoma (probably Burkitt)(Reactive) paracortical hyperplasiaReactive hyperplasiaHIVassociated lymphadenopathy
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19) Enlarged lymph node from the neck of a 12 year old female.IMMUNOHISTOCHEMISTRY: Not yet done
RESIDENTS(Reactive, explosive) follicular hyperplasiaNo answerDiffuse B-ceillymphoma (sinusal types)Kikuchi necrotising lymphadenitis
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DIAGNOSIS: Reactive (follicular/paracortical) hyperplasia with folliclular lysis. 32
20) Left axillary lymphadenopathy in 45 year old female. No breast mass and no skinlesions. ? Lymphoma.IMMUNOHISTOCHEMISTRY: CD20 positive areas well demarcated from CD5 positiveareas. Follicle germinal centres negative with Bcl-2.
CONSULTANTSDermatopathic lymphadenopathy (reactive)No answerMantle cell lymphomaReactive (?chronic lymphadenitis, sinus histiocytosis)Follicular hyperplasla .Atypical hyperplasia (?HIV)Non-Hodgkin's lymphoma
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RESIDENTSNo answerDermatopathic lymphadenopathy (reactive)Reactive (follicular and parafollicular) hyperplasiaDiffuse B-ceillymphomaMantle cell lymphomaMetastatic melanoma
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DIAGNOSIS: Dermatopathic lymphadenopathy 32
21) Enlarged cervical lymph node in 52 year old male. ? Reactive lymphadenopathy.IMMUNOHISTOCHEMISTRY: Tumour cells express CD20 with weak expression of Bcl-2and very weak focal expression of MUM-1. Ki-67 index is nearly 100%. There is noexpression of CD10, cyclin D1 or EBV-lMP1. CD5 marks a very small population ofreactive lymphocytes.
CONSULTANTSDiffuse large B-cell lymphoma (NHl - large B-cell type)No answer 'Non-Hodgkin's lymphomaBurkitt's-like lymphomaMetastatic carcinoma (from small cell carcinoma of lung)Reactive
RESIDENTSDiffuse large B-cell lymphomaNo answerT cell/Histiocyte rich B cell lymphomaNon-Hodgkin's lymphoma? Necrotising inflammationBurkitt lymphomaKikuchi necrotising lymphadenitis
DIAGNOSIS: High grade diffuse large 8 cell non-Hodgkin's lymphoma
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22) Right infraclavicular lymph node from a 62 year old male.IMMUNOHISTOCHEMISTRY: lesional cells express CD20, CD5 and CD23
CONSULTANTSSmall lymphocytic Iymphoma/CllNo answerMantle cell lymphomaNon-Hodgkin's lymphoma
RESIDENTSSmall lymphocytic Iymphoma/CllNo answerAnaplastic lymphomaDermatopathic lymphadenitisSmall lymphocytic lymphoma (mantle)Reactive
DIAGNOSIS: 8 small cell lymphocytic lymphoma/ell
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23) Bladder tumour resection in a 77 year old female who presented with suprapubic pain.Cystoscopy findings included grossly thickened bladder wall and cavity filled with tumour.IMMUNOHISTOCHEMISTRY: Tumour cells are negative for Bcl-2 but express CD20 andCD10 with a Ki-67 index of 100%. CD5 marks a very small population of reactivelymphocytes.
CONSUL TANTSBurkitt's lymphomaNo answerMarginal zone (extranodal) lymphomaMetastatic carcinomaDiffuse large B-cell lymphomaSmall cell carcinoma
RESIDENTSBurkitt's lymphomaNo answermetastatic transitional carcinomaFollicular B-ceillymphomaB-ceillymphoma unclassifiableHodgkin's lymphoma and high grade transitional cell carcinoma
DIAGNOSIS: High grade B-cell non-Hodgkin's lymphoma of Burkitt's type
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24) Incidental finding of enlarged right level II jugular lymph node in a 72 year old male.IMMUNOHISTo.CHEMISTRY: Tumour cells are negative with CD10, but express CD20 andBcl-2. Neoplastic FDC meshwork identified with CD23.
CONSULTANTS'No answerFollicular lymphoma (no grading)large B-cell lymphomaNon-Hodgkin's lymphoma B-cell typeMarginal zone lymphomaFollicular lymphoma (grade 3)
RESIDENTSNo answerFollular (centre cell) lymphoma (no grading)B-cell ell (Sll)Hodgkin's lymphomaDiffuse large B-ceillymphomaFollicular (centre cell) lymphoma (grade 3)Primary mediastinal large B-ceillymphomaFollicular dendritic cell sarcomaSmall B-ceillymphoma (nodular variant)
DIAGNOSIS: WHO grade 3B follicular non-Hodgkin's lymphoma
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2S) Axillary mass from a 32 year old male. History of radiotherapy since April 2011 formultiple myeloma diagnosed after spinal-cord operation.IMMUNO: tumour cells are strongly and uniformly CD30 positive with very focal strongexpression of CD1S. They are negative for CD4S, EBV-LMP1, CD20, CD79a, CD3, CD4,CDS, CD8 and ALK-1.CONSULTANTS
Anaplastic large cell lymphoma (Alk -ve)/High grade anaplastic NHLHodgkin's lymphoma (mixed cellularity)No answerMultiple myelomaAmelanocytic melanomaAnaplastiC large B-cell lymphoma
RESIDENTSHodgkin's lymphoma (nodular sclerosis, classical)No answerAnaplastic large cell lymphoma (ALK -ve)LymphoplasmacytomaB-ceillymphomaDiffuse large B-ceillymphoma (immunoblastic)Nodular lymphocyte predominance Hodgkin's lymphoma
DIAGNOSIS: Lymphocyte depleted classical Hodgkin's lymphoma
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List of participants
CONSUL TANTS
ADAAadeboyADOATBUT@2013AJD1123DeleEda omoF2DgbfsOvayozaSophieT-Toxy
RESIDENTS1278daySsigmaAcMeATURU 44GCCTH ABCD
- GNJ.CLLL