Case 105 - Revision history

Michael: /* Other cases */

2015-09-24T04:28:48Z

Other cases

← Older revision		Revision as of 04:28, 24 September 2015
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	[[Category:Cases]]		[[Category:Cases]]

	~~<!-- SELECT A CATEGORY~~
	[[Category:Cases in gynecologic pathology]]		[[Category:Cases in gynecologic pathology]]
	-->		[[Category:Cases in gynecologic pathology - senior]]

	[[Category:Cases difficulty 4]] <!-- difficulty 1-7 -- should roughly correspond to the PGY level -->		[[Category:Cases difficulty 4]] <!-- difficulty 1-7 -- should roughly correspond to the PGY level -->

Michael: /* Diagnosis */ reformating & wikify a bit

2015-09-23T14:34:26Z

Diagnosis: reformating & wikify a bit

← Older revision		Revision as of 14:34, 23 September 2015
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	===Diagnosis===		===Diagnosis===
	{{hidden\|Diagnosis\|<center>HIGHLY CELLULAR LEIOMYOMA. The differential diagnosis is between an endometrial stromal tumor (nodule or sarcoma) and a highly cellular leiomyoma. Although the immunohistochemical stains can be helpful if CD10 negative, a high percentage of cellular leiomyoma mark with CD10, a stain traditionally assumed to mark stromal tumors. Conversely,endometrial stromal neoplasms with smooth muscle differentiation will mark with muscle markers. The characteristic features of highly cellular leiomyoma are the cleft like spaces at the edge of the tumor, the thick-walled vessels within the tumor, and the "spindled" spindle cells as opposed to rounded spindled cells. They also lack the spiral arterioles characteristic of endometrial stromal neoplasms. The edge of a cellular leiomyoma is often irregular, sometimes raising concern not for an endometrial stromal nodule (which if misdiagnosed as, has no clinical implications) but for an endometrial stromal sarcoma (which does have prognostic and surgical implications). The irregular tongues of tumor in cellular leiomyoma are generally small, do not extend for more than a few millimeters beyond the tumor and "fade" into the surrounding myometrium; whereas these tongues are sharply circumscribed in endometrial stromal sarcoma. ~~</center>~~}}		{{hidden\|Diagnosis\|<center>[[Uterine leiomyoma\|HIGHLY CELLULAR LEIOMYOMA]]</center>

			<br>Comment:<br>The differential diagnosis is between an endometrial stromal tumor ([[endometrial stromal nodule]], [[endometrial stromal sarcoma]]) and a highly cellular leiomyoma. Although the immunohistochemical stains can be helpful if CD10 negative, a high percentage of cellular leiomyoma mark with CD10, a stain traditionally assumed to mark stromal tumors. Conversely, endometrial stromal neoplasms with smooth muscle differentiation will mark with muscle markers.
			<br><br>The characteristic features of highly cellular leiomyoma are the cleft like spaces at the edge of the tumor, the thick-walled vessels within the tumor, and the "spindled" spindle cells as opposed to rounded spindled cells. They also lack the spiral arterioles characteristic of endometrial stromal neoplasms. The edge of a cellular leiomyoma is often irregular, sometimes raising concern not for an endometrial stromal nodule (which if misdiagnosed as, has no clinical implications) but for an endometrial stromal sarcoma (which does have prognostic and surgical implications). The irregular tongues of tumor in cellular leiomyoma are generally small, do not extend for more than a few millimeters beyond the tumor and "fade" into the surrounding myometrium; whereas these tongues are sharply circumscribed in endometrial stromal sarcoma.
			}}
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Michael: adjust labels

2015-09-23T14:14:16Z

adjust labels

← Older revision		Revision as of 14:14, 23 September 2015
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	<center>Low magnification. [[H&E stain]].</center>		<center>Low magnification. [[H&E stain]].</center>

	{{hidden\|~~Intermediate~~ magnification\|[[Image: Highly cellular leiomyoma at edge to myometrium at 20x.jpg \|500px\|link=\|center\|]]		{{hidden\|Low magnification\|[[Image: Highly cellular leiomyoma at edge to myometrium at 20x.jpg \|500px\|link=\|center\|]]
	<center>Low magnification. [[H&E stain]].</center>}}		<center>Low magnification. [[H&E stain]].</center>}}

	{{hidden\|~~High~~ magnification\|[[Image: Highly cellular leiomyoma on showing thick walled vessels at 20x.jpg \|500px\|link=\|center\|]]		{{hidden\|Low magnification\|[[Image: Highly cellular leiomyoma on showing thick walled vessels at 20x.jpg \|500px\|link=\|center\|]]
	<center>Low magnification. [[H&E stain]].</center>}}		<center>Low magnification. [[H&E stain]].</center>}}

Vinita at 18:25, 22 September 2015

2015-09-22T18:25:07Z

← Older revision		Revision as of 18:25, 22 September 2015
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	===Diagnosis===		===Diagnosis===
	{{hidden\|Diagnosis\|<center>HIGHLY CELLULAR LEIOMYOMA. The differential diagnosis is between an endometrial stromal tumor (nodule or sarcoma) and a highly cellular leiomyoma. Although the immunohistochemical stains can be helpful if CD10 negative, a high percentage of cellular leiomyoma mark with CD10, a stain traditionally assumed to ~~marker~~ stromal ~~tumor~~. ~~Likewise~~, ~~if the~~ endometrial stromal ~~neoplasm has~~ smooth muscle differentiation~~, those areas~~ will mark with muscle markers. The characteristic ~~feature is~~ the cleft like spaces at the edge of the tumor, the ~~thickwalled~~ vessels within the tumor, and the spindled spindle cells as opposed to rounded spindled cells. ~~Endometrial stromal neoplasms will have~~ the ~~characteristic~~ spiral arterioles ~~also~~. The edge of a cellular leiomyoma is often irregular sometimes raising ~~the~~ concern not for a nodule but for an endometrial stromal sarcoma. ~~However, the~~ tongues of tumor are generally small, do not extend for more than a few millimeters and "fade" into the surrounding myometrium~~. These~~ tongues are sharply circumscribed in stromal ~~neoplasms~~. </center>}}		{{hidden\|Diagnosis\|<center>HIGHLY CELLULAR LEIOMYOMA. The differential diagnosis is between an endometrial stromal tumor (nodule or sarcoma) and a highly cellular leiomyoma. Although the immunohistochemical stains can be helpful if CD10 negative, a high percentage of cellular leiomyoma mark with CD10, a stain traditionally assumed to mark stromal tumors. Conversely,endometrial stromal neoplasms with smooth muscle differentiation will mark with muscle markers. The characteristic features of highly cellular leiomyoma are the cleft like spaces at the edge of the tumor, the thick-walled vessels within the tumor, and the "spindled" spindle cells as opposed to rounded spindled cells. They also lack the spiral arterioles characteristic of endometrial stromal neoplasms. The edge of a cellular leiomyoma is often irregular, sometimes raising concern not for an endometrial stromal nodule (which if misdiagnosed as, has no clinical implications) but for an endometrial stromal sarcoma (which does have prognostic and surgical implications). The irregular tongues of tumor in cellular leiomyoma are generally small, do not extend for more than a few millimeters beyond the tumor and "fade" into the surrounding myometrium; whereas these tongues are sharply circumscribed in endometrial stromal sarcoma. </center>}}
	<br>		<br>
	===Other cases===		===Other cases===

Vinita at 18:20, 22 September 2015

2015-09-22T18:20:16Z

← Older revision		Revision as of 18:20, 22 September 2015
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	===Differential diagnosis===		===Differential diagnosis===
	{{hidden\|Differential diagnosis\|<center>~~THE DDx GOES HERE~~</center>}}		{{hidden\|Differential diagnosis\|<center>Endometrial stromal neoplasm - nodule vs sarcoma </center>}}

	===Additional tests===		===Additional tests===
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	====Ask a colleague====		====Ask a colleague====
	{{hidden\|Ask a colleague\|<center>~~endometrial stromal tumor versus a cellular leiomyoma.~~ Would immunostains help? </center>}}		{{hidden\|Ask a colleague\|<center> Would immunostains help? </center>}}

	====Stains====		====Stains====
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	===Diagnosis===		===Diagnosis===
	{{hidden\|Diagnosis\|<center>HIGHLY CELLULAR LEIOMYOMA</center>}}		{{hidden\|Diagnosis\|<center>HIGHLY CELLULAR LEIOMYOMA. The differential diagnosis is between an endometrial stromal tumor (nodule or sarcoma) and a highly cellular leiomyoma. Although the immunohistochemical stains can be helpful if CD10 negative, a high percentage of cellular leiomyoma mark with CD10, a stain traditionally assumed to marker stromal tumor. Likewise, if the endometrial stromal neoplasm has smooth muscle differentiation, those areas will mark with muscle markers. The characteristic feature is the cleft like spaces at the edge of the tumor, the thickwalled vessels within the tumor, and the spindled spindle cells as opposed to rounded spindled cells. Endometrial stromal neoplasms will have the characteristic spiral arterioles also. The edge of a cellular leiomyoma is often irregular sometimes raising the concern not for a nodule but for an endometrial stromal sarcoma. However, the tongues of tumor are generally small, do not extend for more than a few millimeters and "fade" into the surrounding myometrium. These tongues are sharply circumscribed in stromal neoplasms. </center>}}
	<br>		<br>
	===Other cases===		===Other cases===

Vinita at 18:09, 22 September 2015

2015-09-22T18:09:13Z

← Older revision		Revision as of 18:09, 22 September 2015
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	====Ask a colleague====		====Ask a colleague====
	{{hidden\|Ask a colleague\|<center>~~COLLEAGUE'S ADVICE HERE~~</center>}}		{{hidden\|Ask a colleague\|<center>endometrial stromal tumor versus a cellular leiomyoma. Would immunostains help? </center>}}

	====Stains====		====Stains====

Vinita at 18:06, 22 September 2015

2015-09-22T18:06:28Z

← Older revision		Revision as of 18:06, 22 September 2015
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	{{hidden\|Intermediate magnification\|[[Image: Highly cellular leiomyoma at edge to myometrium at 20x.jpg \|500px\|link=\|center\|]]		{{hidden\|Intermediate magnification\|[[Image: Highly cellular leiomyoma at edge to myometrium at 20x.jpg \|500px\|link=\|center\|]]
	<center>~~Intermediate~~ magnification. [[H&E stain]].</center>}}		<center>Low magnification. [[H&E stain]].</center>}}

	{{hidden\|High magnification\|[[Image: Highly cellular leiomyoma on showing thick walled vessels at 20x.jpg \|500px\|link=\|center\|]]		{{hidden\|High magnification\|[[Image: Highly cellular leiomyoma on showing thick walled vessels at 20x.jpg \|500px\|link=\|center\|]]
	<center>~~High~~ magnification. [[H&E stain]].</center>}}		<center>Low magnification. [[H&E stain]].</center>}}

	{{hidden\|High magnification\|[[Image: Highly cellular leiomyoma at 200x.jpg \|500px\|link=\|center\|]]		{{hidden\|High magnification\|[[Image: Highly cellular leiomyoma at 200x.jpg \|500px\|link=\|center\|]]

Vinita: Created page with "===Provided clinical history=== 56 year old woman, with history of increased menstrual bleeding. 4.5 cm mass on ultrasound of the uterus ===Site=== Uterus- stromal ===Prima..."

2015-09-22T18:04:12Z

Created page with "===Provided clinical history=== 56 year old woman, with history of increased menstrual bleeding. 4.5 cm mass on ultrasound of the uterus ===Site=== Uterus- stromal ===Prima..."

New page

===Provided clinical history===
56 year old woman, with history of increased menstrual bleeding. 4.5 cm mass on ultrasound of the uterus

===Site===
Uterus- stromal

===Primary image===
[[Image: Highly cellular leiomyoma junction of tumor to myometrium at 20x.jpg |500px|link=|center|]]
<center>Low magnification. [[H&E stain]].</center>

{{hidden|Intermediate magnification|[[Image: Highly cellular leiomyoma at edge to myometrium at 20x.jpg |500px|link=|center|]]
<center>Intermediate magnification. [[H&E stain]].</center>}}

{{hidden|High magnification|[[Image: Highly cellular leiomyoma on showing thick walled vessels at 20x.jpg |500px|link=|center|]]
<center>High magnification. [[H&E stain]].</center>}}

{{hidden|High magnification|[[Image: Highly cellular leiomyoma at 200x.jpg |500px|link=|center|]]
<center>High magnification. [[H&E stain]].</center>}}

===Differential diagnosis===
{{hidden|Differential diagnosis|<center>THE DDx GOES HERE</center>}}

===Additional tests===
====More history====
{{hidden|More history|<center>MORE HISTORY HERE</center>}}

====Ask a colleague====
{{hidden|Ask a colleague|<center>COLLEAGUE'S ADVICE HERE</center>}}

====Stains====
{{Case Stains
| blank=Dr Torres would ask why!
| alcpas=
| alc1=
| alc25=
| aur=
| biel=
| bili=
| iron=
| congored=
| cresylv=
| dieterle=
| diffquik=
| fontana=
| gallyas=
| giemsa=
| gms=
| gomori=
| gram=
| gremelius=
| jms=
| jones=
| kinyoun=
| luxol=
| masson=
| mmas=
| movat=
| mucicar=
| oilredo=
| orecein=
| pas=
| pasd=
| pasf=
| ptah=
| prussian=
| reticulin=
| sudanblackb=
| toluidine=
| verhoeff=
| vonkossa=
| warthinstarry=
| zn=
}}
====IHC====
{{Case IHC
| blank=Dr Torres would ask why!
| a1at=
| acth=
| ae1ae3=
| afp=
| alk1=
| amacr=
| ar=
| atrx=
| b2microglobulin=
| b72_3=
| bcatenin=
| bcl2=
| bcl6=
| bclxl=
| c3=
| ca9=
| calcitonin=
| calponin=
| calretinin=
| cam5p2=
| cathepsink=
| cd10= FOCAL POSITIVE
| cd117=
| cd138=
| cd15=
| cd1a=
| cd20=
| cd21=
| cd23=
| cd3=
| cd30=
| cd31=
| cd34=
| cd35=
| cd4=
| cd43=
| cd45=
| cd5=
| cd56=
| cd57=
| cd68=
| cd7=
| cd79a=
| cd8=
| cd99=
| cdx2=
| cea=
| chromo=
| ck17=
| ck19=
| ck20=
| ck34be12=
| ck5_6=
| ck7=
| cmv=
| cmyc=
| cyclin_d1=
| d2_40=
| desmin= FOCAL POSITIVE
| dog1=
| ebv=
| ema=
| erpr=
| f_viii=
| f_xiiia=
| fascin=
| fh=
| fsh=
| gastrin=
| gata3=
| gcdfp=
| gfap=
| gh=
| glucagon=
| glypican3=
| hbme1=
| hbv_core=
| hbv_surf=
| hcaldesmon= POSITIVE
| hcg=
| helicobacter=
| hepatocyte=
| her2=
| hhv8=
| hmb45=
| hnf1beta=
| hpv=
| hsv1=
| hsv2=
| Idh-1=
| inhibin=
| ini1=
| insulin=
| kappa=
| ki67=
| lambda=
| leu7=
| lga=
| lgg=
| lgm=
| lh=
| lysozyme=
| mammogl=
| map2=
| mcv=
| melanin_a=
| mitf=
| mum1=
| myleoperox=
| myo_d1=
| myog=
| nf=
| nkx3_1=
| nse=
| oct3_4=
| p16=
| p501s=
| p53=
| p57=
| p63=
| panker=
| pax2=
| pax5=
| pax8=
| pcna=
| pdgfr=
| plap=
| pnl-2c=
| prolactin=
| psa=
| psap=
| rcc=
| s100=
| sma= FOCAL POSITIVE
| somatsatin=
| synapto=
| tdt=
| tfe3=
| tfeb=
| thyrogl=
| toxopl=
| tsh=
| ttf1=
| ubiquitin=
| uchl1=
| ulex_europe=
| vim=
| vip=
| vzv=
| wt1=
}}

====Molecular testing====
=====Chromosomal translocations=====
{{Case Translocations
| blank=Dr Torres would ask why!
| t1_13=
| t2_13=
| t8_14=
| t9_22bcr_abl=
| t9_22chn_ews=
| t11_14=
| t11_22dsrct=
| t11_22ews=
| t12_15=
| t12_16afh=
| t12_16liposar=
| t12_22=
| t14_18=
| t15_17=
| t16_21=
| t17_22=
| t21_22=
| tx_1=
| tx_17=
| tx_18=
}}
=====Other molecular tests=====
{{Case Molecular
| blank=Dr Torres would ask why!
| alk =
| b_cell_clone =
| bcl2 =
| braf =
| EBV_pcr =
| egrf =
| h3f3a =
| hhv8_pcr =
| identity_test =
| idh1_2 =
| jak2_v617f =
| kit =
| loh_1p19q =
| t_cell_clone =
}}

===Diagnosis===
{{hidden|Diagnosis|<center>HIGHLY CELLULAR LEIOMYOMA</center>}}
<br>
===Other cases===
{{Cases navigation}}

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[[Category:Cases difficulty 4]]