South East England General Histopathology EQA Scheme Meeting Overview
The South East England General Histopathology EQA Scheme Meeting on Wednesday, 29th March 2023, covers case discussions, meeting etiquette, agenda items, round reviews, and guidelines for case consultation and merging. The meeting provides an educational opportunity for attendees to understand scoring decisions and exclusions. Attendees may receive CPD points, and participation feedback is encouraged.
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South East England General Histopathology EQA Scheme Case Discussion Round u Wednesday 29thMarch, 2023 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 877-886 b) Educational Cases 887 - 888 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 153 responses received for round u xx responses received for consultation xx:xx% 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.
Case 877 Miscellaneous Specimen: Knee Tissue Submitted Diagnosis: Chondromatosis Submitted Clinical Macro Immuno Image link Preliminary Results Final Merge Results M35. Synovial Mass right knee Nodule 20x15x8mm N/A Click here to view digital image 1. Synovial Chondromatosis 9.64 2. Synovial Cyst (Baker's cyst) 0.07 3. Loose bodies in osteoarthritis ? hx of trauma 0.01 4. Chondrosarcoma 0.22 5. Juxtacortical chondroma 0.07
Case 878 Respiratory Specimen: Lung Submitted Diagnosis: Metastation lung adenocarcinoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results M68. LLL lesion.?cancer. Multiple haemorrhagic fragments and grey fine needle biopsies aggregate 19mm. CK7+, TTF1 focal positive. Click here to view digital image 1. Metastatic NSCLC 9.10 2. Adenocarcinoma 0.88 3. Metastatic thyroid carcinoma 0.02 EBUS Station 4R. CDX2-, NKX3.1-
Case 879 Endocrine Specimen: Thyroid Submitted Diagnosis: Follicular carcinoma (encapsulated angioinvasive) Vascular invasion is present in the slides. Obvious capsular invasion is seen elsewhere. Clinical Macro Immuno Image link Preliminary Results Final Merge Results M19. Left 4cm U4 Thy3F thyroid nodule. Left hemithyroidectom y. There is a lobe of thyroid measuring 57 x 42 x 43 mm which has been inked black and serially sliced. N/A Click here to view digital image 1. Minimally invasive follicular carcinoma 1.80 2. Follicular thyroid carcinoma 5.68 3. Encapsulated angioinvasive follicular carcinoma 1.11 4. Minimally Invasive angioinvasive follicular 1.13 carcinoma 5. Thyroid follicular carcinoma widely invasive 0.07 6. Follicular neoplasm of uncertain malignant 0.10 potential 7. Invasive encapsulated follicular variant of 0.11 papillary Ca This reveals an expansile nodule measuring 38mm in maximum dimension which is encapsulated. The edge of the nodule has been extensively sampled.
Case 880 Gynae Specimen: Uterus Submitted Diagnosis: Pleomorphic leimoyoma Clinical Macro Immuno Image link Preliminary Results Final Merge Results F82. ? Sarcoma of uterus. (PET pos; known lung adenocarcinoma) A uterus measuring 45mm (medial to lateral) x 40mm (anterior to posterior) x 70mm in length. The immuno stains show that the tumour cells are positive for Desmin, SMA, and caldesmon. Click here to view digital image 1. Leiomyosarcoma 0.14 2. Symplastic Leiomyoma 8.48 3. Smooth muscle tumour of uncertain 0.53 malignant potential 4. Atypical leiomyoma 0.30 5. FH Deficient leiomyoma 0.24 6. PECOMA 0.01 7. Ancient leiomyoma 0.07 8. Leiomyoma 0.20 9. Cellular leiomyoma 0.01 The cervix measures 25 x 25 x 25mm. They are negative for CD34, CD117, CD10 and factor VIII. The cut surface of the uterus shows a firm, well-defined mass lesion showing a regular margin and a smooth tan cut surface, 30mm in maximum diameter. The Ki67 level index is less than 2% in the tumour cells.
Case 881 Lymphoreticular Specimen: Nodule from gastrectomy specimen Submitted Diagnosis: Splenunculus Clinical Macro Immuno Image link Preliminary Results Final Merge Results M59. Subtotal gastrectomy for distal adenocarcinom a post- neoadjuvant treatment Nodule found within fibroadipose tissue submitted separately to main stomach specimen. N/A Click here to view digital image 1. Benign Splenunculus 9.68 2. Reactive node 0.11 3. Reactive - Kimura's disease 0.07 4. Benign LN with vascular transformation of 0.14 sinuses
Case 882 Breast Specimen: Breast Submitted Diagnosis: Granular Cell Tumour Clinical Macro Immuno Image link Preliminary Results Final Merge Results F81. R5, U5.WBN left breast Three cores 14-22mm S100+, CD68 focal + Click here to view digital image 1. Granular Cell tumour 10.0 MNF116 - , CK AE1/3 - , CD1a -
Case 883 GU Specimen: Testis Submitted Diagnosis: Metastic adenocarcinoma with neuroendocrine differentiation (likely carcinoma ex goblet cell carcinoid from appendix or colorectum). Clinical Macro Immuno Image link Preliminary Results Final Merge Results M69. Undescended testis. Testis measuring 60x3520mm with short stump spermatic cord, 20x15mm in cross section. Positive for MNF116, CAM 5.2, CK20, CDX2 and neuroendocrine markers (chromogranin, synaptophysin and patchy CD56). Click here to view digital image 1. Metastatic goblet cell carcinoid / 9.25 adenocarcinoma 2. Spermatocele 0.07 3. Mucinous cystadenoma 0.07 4. Mature cystic teratoma 0.07 5. Benign epididymal cyst 0.14 6. Cystic dilation of rete testis secondary to 0.07 obstruction 7. Teratoma with well differentiated 0.17 neuroendocrine tumour 8. Poorly differentiated sertoli cell tumour 0.03 9. Sertoli-leydig cell tumour 0.14 Negative for CK7. Beta-catenin shows membranous staining. On slicing a cystic lesion is present measuring 45x20x20mm.
Case 884 GI Specimen: Salivary Gland Submitted Diagnosis: Benign monocytic salivary duct cyst. Clinical Macro Immuno Image link Preliminary Results Final Merge Results M69. Mucocele and overlying polyp. R buccal mucosa. Mucosa 12x8x8mm with 8mm pale nodule. N/A Click here to view digital image 1. Benign salivary duct cyst +/- oncocytic 4.43 changes 2. Salivary gland cystadenoma 4.18 3. Oncocytoma 0.39 4. Oncocytic / apocrine metaplasia in a - mucoele 5. Apocrine Hidrocystoma 0.13 6. Oncocytic salivary duct ectasia 0.07 7. Warthin tumour 0.13 8. Oncocytic / apocrine metaplasia 0.13 9. Intraductal papilloma 0.07 10. Mucoepidermoid carcinoma 0.07 0.39
Case 885 Skin Specimen: Skin Submitted Diagnosis: Fibrous histiocytoma - fibrocollagenous variant. Clinical Macro Immuno Image link Preliminary Results Final Merge Results F52. ? Tyloma or verruca Ellipse of rubbery pale skin 27 x 9 x 7mm. Positive: Factor 13a. Click here to view digital image 1. Callus / Corn / ? reactive changes 0.20 2. Dermatofibroma 9.64 3. Aponeurotic fibroma (calcifying) 0.07 4. Neurofibroma 0.07 5. Verruca 0.03 Negative: CD31, CD34, S100. Equivocal: SMA.
Case 886 Gynae Specimen: Placenta Submitted Diagnosis: Chorangioma. Clinical Macro Immuno Image link Preliminary Results Final Merge Results F32. Placenta ? Chorioamnio nitis Placental disc contains a solid circumscribed pale nodules lesion 40 x 30 x 40mm N/A Click here to view digital image 1. Chorangioma +/- infarct 9.19 2. Haemangioma 0.35 3. Infarct 0.46
Case 887 Skin (EDUCATIONAL) Specimen: Lesion Clinical Macro Immuno Image link Suggested Diagnosis (Top 10) Submitted Diagnosis M53. Nodular lesion, 2 years? Aetiology, ?? BCC Cream punch biopsy 8mm in diameter to a depth of 9mm IHC: SMA, DESMIN AND H-CALDESMON: POSITIVE. Click here to view digital image 1. Leiomyosarcoma x 32 2. Cutaneous Leiomyosarcoma x 29 3. Leiomyoma x 26 4. Atypical intradermal smooth muscle x 11 neoplasm 5. Pilar leiomyoma x 9 6. Cutaneous leiomyoma x 8 7. Atypical leiomyoma x 5 8. Atypical smooth muscle tumour x 4 9. Atypical smooth muscle neoplasm x 4 10. Atypical intradermal smooth muscle x 3 tumour/Cutaneous leiomyosarcoma Dermal leiomyosarcoma (a typical dermal smooth muscle tumour) S-100, CD10, CD117 AND CD34:NEGATIVE
Case 888 GU (EDUCATIONAL) Specimen: Spermatic cord Clinical Macro Immuno Image link Suggested Diagnosis (Top 10) Submitted Diagnosis M85. Left orchidectomy. Emergency repair of obstructed recurrent left inguinal hernia. Removal of ischaemic omentum left orchidectomy. Left testicle with spermatic cord 53g. Cord with adherent fibrous fatty tissue measures approximately 100 x 20mm. Congo Red Positive Click here to view digital image 1. Amyloidosis x 111 2. Amyloid x 41 3. Amyloidosis in the blood vessels. Angio- lipomatous tissue Proximal obstruction. Amyloid angiopathy Tunica vaginalis translucent and mobile. Testicle measures 62 x 34 x 20mm. Epididymis measures 22 x 7 x 6mm. On opening the testicle has a light yellow, slightly congested cut surface. No obvious lesions are identified. Epididymis has a tan/brown appearance. Tunica vaginalsis is slightly oedematous.
4. Questions Comments Suggestions Feedback Thank you for attending. This presentation can be found on the EQA website from next week.
