South East England Histopathology EQA Scheme Meeting - November 30, 2022

South East England General Histopathology EQA Scheme Case Discussion Round is scheduled for Wednesday, November 30, 2022. The meeting entails review of cases, meeting etiquette, terms of reference, and round review. Participants are expected to engage by muting mics when not speaking, following meeting protocols, and actively participating in discussions. Attendance for over 50% of the meeting is required for CPD point eligibility. Feedback is appreciated for continuous improvement.

• Histopathology
• EQA Scheme
• Meeting Etiquette
• Case Discussion
• Educational Exercise

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1. South East England General Histopathology EQA Scheme Case Discussion Round t Wednesday 30thNovember, 2022 THANK YOU FOR WAITING The meeting will start at 12:00pm

2. 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

3. Agenda 1. Welcome & Introduction of Scheme Staff 2. Meeting Terms of Reference 3. Case and Preliminary Score Review a) Case 865-874 b) Educational Cases 875 - 876 4. Questions / comments

4. 2. Meeting Terms of Reference

5. 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.

6. 3. Round t Review

7. CaseConsultation 156 responses received for round t 91 responses received for consultation 58.33% 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 also 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.

8. Case 865 Respiratory Specimen: Right lower lobe Submitted Diagnosis: Pulmonary Hamartoma Submitted Clinical Macro Immuno Image link Preliminary Results Final Merge Results M51. 38mm RLL Mass, enlarging and faintly FDG avid. Asthma Two cores 6 & 8 mm N/A Click here to view digital image 1. Chondroid / pulmonary hamartoma 9.53 2. Lipoma 0.07 3. Cartilaginous hamartoma 0.14 4. Chondroma 0.07 5. Chondrosarcoma 0.07 6. Enchondroma 0.07 7. Benign-Chronic inflammation 0.07 32.94% Agreed to merge 1,3,4. This will give xx% agreement.

9. Case 866 Endocrine Specimen: Thyroid Submitted Diagnosis: Hyalinising trabecular tumour Clinical Macro Immuno Image link Preliminary Results Final Merge Results F41. Left hemithyroidectomy for Thy3f thyroid nodule (not included in the slide). Incidental finding in one tissue block A thyroid lobe weighing 66g and measuring 79x60x36mm. TTF-1(+), Thyroglobulin (+), HBME-1 (-), Calcitonin (-), DPAS stain: Positive intratrabecular hyalin Click here to view digital image 1. Hyalinising adenoma and thyroiditis 4.28 2. Hashitmoto thyroiditis with 0.33 micropapillary carcinoma 3. Papillary carcinoma 0.09 4. Hyalinising adenoma 4.91 (thyroiditis not mentioned) 5. Papillary microcarcinoma 0.07 6. Chronic Thyroiditis (Hashimoto) 0.07 7. Tall cell variant micropapillary 0.26 adenocarcinoma 79.78% Agreed to merge 1, 4 The main tan nodule measures 55x48x37mm (not included in the slide). This will give xx% agreement Incidental finding (lesion not seen grossly).

10. Case 867 Gynae Specimen: Loop biopsy of cervix Submitted Diagnosis: Mesonephric/gartner's duct remnants Clinical Macro Immuno Image link Preliminary Results Final Merge Results F27. Cervical smear showed severe dyskaryosis. Colposcopy - ?microinvasive Loop biopsy 23 x 20 x 13 including the os. Immuno shows positivity for CD10 and low Ki67 index Click here to view digital image 1. Mesonephric hyperplasia / Remnants 8.84 2. Mesonephric adenocarcinoma 0.41 3. Minimal deviation adenocarcinoma 0.54 4. Papillary endocervicitis 0.07 5. Microglandular adenosis 0.07 6. Endocervical polyp 0.07 7. Metastatic carcinoma 0.01 79.07% Agreed not to merge any other categories. This will give xx% agreement.

11. Case 868 Lymphoreticular Specimen: Left Axillary Node Submitted Diagnosis: Sarcoidosis (Granulomatous Lymphadenitis) Clinical Macro Immuno Image link Preliminary Results Final Merge Results F75. Hypercalcemia and widespread adenopathy ? Lymphoma. Past medical history of arthritis, uveitis, erythema nodosum Left axillary node biopsy. Three cores 13- 17mm N/A Click here to view digital image 1. Sarcoidosis 8.16 2. Granulomatous lymphadenitis 0.50 DD incl sarcoid / infectious / Crohns etc 3. Non-caseating granulomatous 1.27 inflammation NOS 4. Lofgren Syndrome 0.07 Xx% Merge 1, 2, 3, 4 This is a clinical override. Insert reason

12. Case 869 Breast Specimen: Breast Submitted Diagnosis: High grade DCIS (solid and cribriform, with comedo necrosis). Multiple foci of invasive NST carcinoma in other blocks. Clinical Macro Immuno Image link Preliminary Results Final Merge Results F44. Left skin sparing mastectomy Mastectomy specimen weighing 270g and measuring 12 x 11 x 4cm. Extensive ill-defined area of grittiness in UOQ measuring 9.5cm maximally. N/A Click here to view digital image 1. DCIS - High Grade 7.16 2. DCIS - intermediate grade 0.20 3. Pleomorphic LCIS 0.07 with comedo necrosis 4. DCIS NOS 1.42 5. DCIS - High grade ? microinvasion 0.34 6. Microinvasive ductal carcinoma 0.31 and DCIS 7. Invasive ductal carcinoma and DCIS 0.07 8. DCIS. Comedo necrosis 0.27 9. Grade 3 DCIS with comedo necrosis 0.14 10. DCIS-like-invasive carcinoma. (IHC) 0.03 52.33% Agreed to merge 1, 2, 4, 8, 9. This will give Xx % agreement.

13. Case 870 GU Specimen: Bladder Submitted Diagnosis: Cystitis Glandularis Clinical Macro Immuno Image link Preliminary Results Final Merge Results M36. Small lesion ? inverted papilloma of bladder trigone One piece of pale tissue measuring 3mm N/A Click here to view digital image 1. Cystitis Glandularis / cystica 9.79 2. Prostatic type polyp 0.07 3. Nephrogenic adenoma 0.07 4. Prostatic acinar and Glandular 0.07 metaplasia & Von Brunn s nests 69.88% Agreed not to merge any other categories. This will give xx% agreement.

14. Case 871 Miscellaneous Specimen: Left lateral thigh Submitted Diagnosis: Haemosiderotic, Aneurysmal cellular fibrous histiocytoma. Clinical Macro Immuno Image link Preliminary Results Final Merge Results F53. Three-year history of pedunculated pink nodule gradually increasing in size ?Neurofibroma ? dermatofibroma, ? DFSP, ? SCC, ? BCC. A shave disk of skin 22 x 22mm IHC Positive for Factor XIIIa. Negative for CD34, S100, Actin and Desmin. Ki67 is low <1% Click here to view digital image 1. Dermatofibroma - aneurysmal variant 5.68 2. Dermatofibroma - haemosiderotic variant 1.00 3. Dermatofibroma - angiomatoid variant 1.52 4. Dermatofibroma - aneurysmal and 0.39 haemosiderotic variant 5. Dermatofibroma NOS 0.90 6. Xanthogranuloma 0.06 7. Glomus tumour 0.13 8. Dermatofibroma - aneurysmal 0.26 and angiomatoid 9. Capillary haemangioma 0.06 69.23% Agreed to merge 1, 2, 3, 4, 5, 8. This will give xx% agreement.

15. Case 872 GI Specimen: Right hemicolectomy Submitted Diagnosis: Fat necrosis secondary to acute pancreatitis Clinical Macro Immuno Image link Preliminary Results Final Merge Results F38. Laparotomy for haemorrhagic pancreatitis The caecum and ascending colon are dilated and their surface shows adherent fibrin and blood. The mucosa appears oedematous. N/A Click here to view digital image 1. Pancreatitis with fat necrosis 6.34 2. Mesenteric fat necrosis 0.39 3. Amoebic colitis 0.03 4. Fat necrosis 2.99 (role of pancreas not mentioned) 5. Steatonecrosis 0.03 6. Ischaemia 0.08 8. Lipomatous proliferation 0.06 9. Colonic paralytic ileus 0.03 10. Large bowel pseudo obstruction 0.04 56.67% Agreed to merge 1, 2, 4, 5. This will give xx% agreement.

16. Case 873 Skin Specimen: Skin Submitted Diagnosis: Sebacous hyperplasia Clinical Macro Immuno Image link Preliminary Results Final Merge Results M66. ?BCC tip of nose Disc of skin 8 x 7mm, depth 2mm. There is a raised, pale nodule 3mm across N/A Click here to view digital image 1. Sebaceous hyperplasia 8.51 2. Sebaceous adenoma 1.23 3. Sebaceous trichofolliculoma 0.13 4. Sebaceous adenoma in background 0.06 of hyperplasia 5. Sebaceous naevus 0.06 32.22% Agreed to merge 1, 2, 4. This will give xx% agreement.

17. Case 874 Lymphoreticular Specimen: Nose biopsy Submitted Diagnosis: Mantle Cell Lymphoma. Clondality results showed clonal IG gene, consistent with mantle cell lymphoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results M74. nasopharyng eal lesion. ?Lymphoma. Asymmetric tonsil L>R. Biopsy from post nasal space. Tissue aggregates 15 x 15 x 4mm Positive: CD20, PAX-5, CD5, Cyclin D1, SOX-11, BCL-2, weak CD43. Scattered - CD10, BCL-6, CD21, CD23. Click here to view digital image 1. Mantle Cell Lymphoma 9.86 2. Small lymphocytic lymphoma 0.07 3. Diffuse large B cell lymphoma 0.07 - activated subtype (germinal centre) 93.83% Agreed not to merge any other categories. Negative: CD30, EBER- ISH, AE1/AE3. No light chain restriction. This will give xx% agreement.

18. Case 875 Lymphoreticular (EDUCATIONAL) Specimen: Lymph node Clinical Macro Immuno Image link Suggested Diagnosis (Top 10) Submitted Diagnosis F54. Rt axillary LN Nodular tan tissue 20x10x10m m with tattooing at one end. Cut surface is solid and yellow white Large cells: CD45+, CD30-, MUM1-, CD20+, CD15- Click here to view digital image 1. Nodular lymphocyte predominant x 114 Hodgkins disease 2. DIFFUSE LARGE B-CELL LYMPHOMA x 6 3. T-cell rich large B-cell lymphoma x 3 4. Lymphoma ? Hodgkin type x 2 5. T-cell/Histiocyte-Rich Large B-Cell Lymphoma x 2 6. T-cell rich B-cell Non-Hodgkin s lymphoma x 2 7. Lymphoma x 2 8. High grade B cell lymphoma 9. Diffuse large B cell lymphoma subtype with abundant nonneoplastic T cells and histiocytes 10. Reactive lymphoid hyperplasia (? EBV-related) Nodular lymphocyte predominant Hodgkins Lymphoma

19. Case 876 Lymphoreticular (EDUCATIONAL) Specimen: Bone Marrow Trephine Clinical Macro Immuno Image link Suggested Diagnosis (Top 10) Submitted Diagnosis F42. Splenomegaly +/- lymphadenopathy A1 = Core measuring 7mm A2 = Clot 5 x 4 x 2 mm CD68 positive Digital Image A1 1. Gaucher s disease x 60 2. Storage disease / disorder x 38 3. Langerhans cell histiocytosis x 12 4. Erdheim-Chester disease x 12 5. Niemann-Pick Disease (Acid Sphingomyelinase Deficiency) x 7 6. Rosai-Dorfman disease x 5 7. Crystal storing histiocytosis x 5 8. Histiocytosis, ? LCH x 5 9. Leishmaniasis x 4 Suggestive of Gauches's disease Digital Image A2

20. 4. Questions Comments Suggestions Feedback Thank you for attending. This presentation can be found on the EQA website from next week.