South East England General Histopathology EQA Scheme Meeting
The South East England General Histopathology EQA Scheme meeting on Tuesday, 30th July 2024, is set to discuss cases, review scores, and address questions. The meeting will cover meeting etiquette, agenda topics, meeting terms of reference, and round Y review. Attendees are reminded of the educational nature of the meeting and the criteria for gaining CPD points. The meeting also emphasizes the rules for case consultation and merging diagnostic categories to ensure efficiency and accuracy.
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South East England General Histopathology EQA Scheme Case Discussion Round y Tuesday 30thJuly, 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 927-936 b) Educational Cases 937-938 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 162 responses received for round y 89 responses received for consultation 55% 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 927 GU Specimen: Testis Submitted Diagnosis: Leydig Cell Hyperplasia Clinical Macro Immuno Image link Preliminary Results Final Merge Results Submitted M35. Testicular pain? cancer Cut surface shows multiple small yellowish nodules. N/A Click here to view digital image 1. Leydig Cell Hyperplasia 8.64 2. Leydig Cell Hyperplasia with Sertoli Cell 0.91 only syndrome 3. Leydig cell tumour 0.27 4. Testis - Leydig cell tumour. Hilum 0.06 - angioleiomyoma 5. Granulosa cell tumour 0.06 6. Interstitial cell hyperplasia 0.06 Merge 1, 2 75.90% agreement
Case 928 Endocrine Specimen: Thyroid Submitted Diagnosis: Hashimoto's thyroiditis with papillary carcinoma (pT1) Clinical Macro Immuno Image link Preliminary Results Final Merge Results F45. Patient with known Hashimoto's thyroiditis. Total thyroidectomy. Enlarged thyroid with white nodules in left and right lobes. None Provided Click here to view digital image 1. Papillary carcinoma with Hashimotos 5.60 thyroiditis 2. Papillary carcinoma 3.77 3. Papillary microcarcinoma 0.44 4. Lymphocytic Thyroiditis / Hashimotos 0.13 5. Hyalinising trabecular tumour of thyroid 0.06 Merge 1, 2, 3 60.92% agreement
Case 929 Respiratory Specimen: Pleural Biopsy Submitted Diagnosis: Metastatic Adenocarcinoma of Lung Origin. Clinical Macro Immuno Image link Preliminary Results Final Merge Results M73. Pleural biopsy (left). Left sided pleural effusion. PMHx: HRN, BPH, Hypercholestosis. Merge 1, 4 Firm pieces of fibrofatty tissue 60mm in aggregate. CK7 - 3+, TTF1 - 3+, MOC31 - 3+, BEREP4 - 3+ Click here to view digital image 1. Adenocarcinoma of lung 9.04 2. Adenocarcinoma of ? papillary thyroid origin 0.23 3. Papillary Adenocarcinoma of ? urothelial origin 0.06 4. Primary Adenocarcinoma 0.06 5. Papillary carcinoma - thyroid or lung 0.35 6. Adenocarcinoma 0.13 7. Metastatic adenocarcinoma 0.13 55.95% Agreement Sliced and all taken in 6 blocks. Penicillin allergy. Procedure: Left VATS drainage and pleural biopsy +TALC pleurodeses.? Malignancy
Case 930 Lymphoreticular Specimen: BMT Submitted Diagnosis: Mast cell proliferation consistent with systemic mastocytosis Clinical Macro Immuno Image link Preliminary Results Final Merge Results This case will be excluded as consensus could not be reached M38. sm/up on oral pred previous arrest following bee sting. Single bony core measuring 18mm in length, 3mm in diameter. CD34/CD117 - no increased blasts. Click here to view digital image 1. Mastocytosis 4.42 2. Malakoplakia 0.07 3. Refer to Haempath / Abnormal 0.51 /reactive 4. Idiopathic hypereosinophilic 3.12 syndrome / eosinophilia 5. Chronic eosinophilic leukaemia 0.32 / CML 6. Lymphoproliferative disease / 0.20 Granulocyte hyperplasia 7. LCH / Rosai-Dorfman disease 0.38 8. Fibrosis/myleoproliferative/ 0.64 myleodysplastic/ morphologically abnormal 9. Metastatic GIST 0.07 10. Allergy / hypersensitivity / fungal 0.27 Blood clot included. All taken for decal. No adrenaline widespread skin lesions, difficult to control.
Case 931 Gynae Specimen: Ovary Submitted Diagnosis: Bilateral metastatic adenocarcinoma of ovary (Krukenberg tumour) Clinical Macro Immuno Image link Preliminary Results Final Merge Results Merge 1, 2, 4 F65. Post- menopausal bleeding. ?sarcoma. Bilateral enlarged ovaries, right ovary 80 x 60 x 45mm and left ovary 35 x 30 x 10mm. Lesional cells positive to BEREP4, Cam 5.2, E-cadherin, CK7, CK20, CDX2 and CEA. Negative to ER, PR, WT-1, TTF-1, Inhibin, Calretinin, Desmin & SMA. The patient on further investigation had linitis plastcia (biopsy proven - adenocarcinoma with signet ring cell differentiation of stomach) Click here to view digital image 1. Metastatic Gastric adenocarcinoma 9.75 (Krukenburg tumour) 2. Metastatic adenocarcinoma with signet 0.06 cells & sarcomatoid component 3. Metastatic appendiceal signet ring cell 0.06 adenocarcinoma 4. Metastatic adenocarcinoma 0.13 51.16% Agreement At laparotomy, ?bilateral fibromas. Hysterectomy and BSO Cut section of both solid, white and lobulated.
Case 932 GI Specimen: Soft Tissue Submitted Diagnosis: Traumatic neuroma Clinical Macro Immun o Image link Preliminary Results Final Merge Results M43. Mass right parotid region. Fibrofatty tissue 28 x 25 x 10mm. None provided Click here to view digital image 1. (Traumatic) Neuroma 8.49 2. Neurofibroma 1.42 3. Neurothekeoma 0.06 4. Schwannoma 0.01 5. Benign neural tumour 0.02 Merge 1, 5 44.32% agreement History of pleomorphic adenoma. Slicing reveals a well circumscribed pale area 18 x 12 x 8mm.
Case 933 Skin Specimen: Skin Submitted Diagnosis: Sebaceous gland hyperplasia Clinical Macro Immuno Image link Preliminary Results Final Merge Results M45. Skin tag right side of nose None Provided None Provided Click here to view digital image 1. Sebaceous Hyperplasia 8.82 2. Sebaceous Adenoma 1.03 3. Sebaceoma 0.02 4. Rhinosporidiosis 0.01 5. Fibrofolliculoma 0.06 6. Sebaceous naevus 0.06 No merge 53.49% agreement
Case 934 Breast Specimen: Breast Submitted Diagnosis: Grade 2 invasive lobular carcinoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results F50. Right Breast. P3, M4, U5 lesion 32g. 65x40x25m m. Firm white mass. 30mm ER positive. HER-2 negative. Click here to view digital image 1. Invasive carcinoma NST 1.05 2. Tubulo-lobular carcinoma 2.17 3. mixed ductal and (pleomorphic) lobular 3.75 carcinoma 4. Invasive lobular carcinoma 3.00 5. Invasive tubular carcinoma 0.03 This case will be excluded from scoring. All suggested merges did not reach consensus E-cadherin, incomplete membrano us reactivity.
Case 935 Miscellaneous Specimen: Tissue from knee Submitted Diagnosis: Chronic synovitis, favour rheumatoid arthritis. Clinical Macro Immun o Image link Preliminary Results Final Merge Results M73. Biopsies of free tissue in knee joint. Multiple pieces of yellow / white soft tissue 30 x 20 x 6 mm. None Provided Click here to view digital image 1. Synovitis - lipomatosis not mentioned 0.50 2. Osteoarthritis 0.06 3. Synovial Lipomatosis / Lipoma 7.93 arborescens 4. Papillary synovitis with prominent 0.06 plasma cells; PVNS 5. Lipoma 0.12 6. Rheumatoid arthritis 1.27 7. Inflammation and fat necrosis 0.06 Merge 1, 3, 6 Clinical Over-ride to include 6
Case 936 Digital Only - Miscellaneous Specimen: Spinal Tumour Submitted Diagnosis: Psammomatous meningioma Clinical Macro Immuno Image link Preliminary Results Final Merge Results M79. Progressive paraparesis, dural based tumour at T11 Gritty tissue fragments. None Provided Click here to view digital image 1. Meningioma 9.94 2. Diffuse spinal dural calcification 0.06 No merge 100% agreement
Case 937 EDUCATIONAL Specimen: Soft Tissue from penis Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis M70. Para- urethral cyst at the base of the penis Single piece of un-oriented partly membrane covered soft tissue 90x65x20mm with attached fibrous tissue 45x20x5mm. CD34: Diffusely positive. Click here to view digital image 1. Angiomyxoma x 73 2. Cellular Angiofibroma x 44 3. Solitary fibrous tumour x 12 4. Angiomyofibroblastoma x 5 5. Myofibroblastoma mammary type x 3 Cellular Angiofibroma ER: Scattered cells expressing positive staining MNF116 / S100 / STAT6: Negative. Case was referred for specialist opinion. External surface cystic structures filled with fluid, 10mm in largest dimension. Soft spongy grey/white filled serous / mucoid material.
Case 938 EDUCATIONAL Specimen: EBUS Station 7 Clinical Macro Immuno Image link Suggested Diagnosis (Top 5) Submitted Diagnosis F29. Arthralgia, erythema nodosum and large mediastinal lymphadenopathy. Multiple pieces of haemorrhagic and cream cores in aggregate, 20 x 20mm. Stains for micro- organisms negative Click here to view digital image 1. Sarcoidosis x 145 2. Granulomatous inflammation x 8 3. Granulomatous lymphadenitis x 10 4. Granulomata? Related to erythema x 1 nodosum? intermixed interdigitating dendritic reticulum cells Sarcoidosis
4. Questions Comments Suggestions Feedback Thank you for attending. This presentation can be found on the EQA website from next week.
