Difference between revisions of "Case 116"

Latest revision as of 03:17, 27 September 2015

Provided clinical history

45 year old woman, with intractable uterine bleeding unresponsive to hormone therapy. Mass lesion in the myometrium

Site

Uterus- myometrium

Primary image

Low magnification. H&E stain.

High magnification
High magnification. H&E stain.

Differential diagnosis

Differential diagnosis
Smooth muscle tumour of uncertain malignant potential (STUMP), uterine leiomyosarcoma

Additional tests

More history

More history
Patient had received lysteda for control of bleeding.

Ask a colleague

Ask a colleague
Did you check the history? I wonder whether this could be drug effect.

Stains

Alcian blue/PAS to Bilirubin

Test	Result
Alcian blue/PAS	Dr Torres would ask why!
Alican blue pH 1.0	Dr Torres would ask why!
Alcian blue pH 2.5	Dr Torres would ask why!
Auramine	Dr Torres would ask why!
Bielchowsky	Dr Torres would ask why!
Bilirubin	Dr Torres would ask why!

Colloidal iron to Fontana-Masson

Test	Result
Colloidal iron	Dr Torres would ask why!
Congo red	Dr Torres would ask why!
Cresyl violet	Dr Torres would ask why!
Dieterle	Dr Torres would ask why!
Diff Quik	Dr Torres would ask why!
Fontana-Masson	Dr Torres would ask why!

Gallyas to Gremelius

Test	Result
Gallyas	Dr Torres would ask why!
Giemsa	Dr Torres would ask why!
GMS	Dr Torres would ask why!
Gomori's trichrome	Dr Torres would ask why!
Gram	Dr Torres would ask why!
Gremelius	Dr Torres would ask why!

JMS to Mucicarmine

Test	Result
JMS	Dr Torres would ask why!
Jones	Dr Torres would ask why!
Kinyoun	Dr Torres would ask why!
Luxol fast blue	Dr Torres would ask why!
Masson trichrome	Dr Torres would ask why!
M-MAS	Dr Torres would ask why!
Movat	Dr Torres would ask why!
Mucicarmine	Dr Torres would ask why!

Oil red O to Prussian blue

Test	Result
Oil red O	Dr Torres would ask why!
Orecein	Dr Torres would ask why!
PAS	Dr Torres would ask why!
PASD	Dr Torres would ask why!
PASF	Dr Torres would ask why!
PTAH	Dr Torres would ask why!
Prussian blue	Dr Torres would ask why!

Reticulin to Ziehl-Neelsen

Test	Result
Reticulin	Dr Torres would ask why!
Sudan black B	Dr Torres would ask why!
Toluidine blue	Dr Torres would ask why!
Verhoeff	Dr Torres would ask why!
Von Kossa	Dr Torres would ask why!
Warthin-Starry	Dr Torres would ask why!
Ziehl-Neeslen	Dr Torres would ask why!

IHC

Alpha-1 AT to Cathepsin K

Test	Result
alpha-1 AT	Dr Torres would ask why!
ACTH	Dr Torres would ask why!
AE1/AE1	Dr Torres would ask why!
alpha-fetoprotein	Dr Torres would ask why!
Alk-I	Dr Torres would ask why!
AMACR	Dr Torres would ask why!
AR	Dr Torres would ask why!
ATRX	Dr Torres would ask why!
Beta2-microglobulin	Dr Torres would ask why!
B72.3	Dr Torres would ask why!
Beta-catenin	Dr Torres would ask why!
BCL2	Dr Torres would ask why!
BCL6	Dr Torres would ask why!
BCLxL	Dr Torres would ask why!
C3 comp	Dr Torres would ask why!
CA9	Dr Torres would ask why!
Calcitonin	Dr Torres would ask why!
Calponin	Dr Torres would ask why!
Calretinin	Dr Torres would ask why!
CAM5.2	Dr Torres would ask why!
Cathepsin K	Dr Torres would ask why!

CD10 to Chromogranin

Test	Result
CD10	Dr Torres would ask why!
CD117	Dr Torres would ask why!
CD138	Dr Torres would ask why!
CD15	Dr Torres would ask why!
CD1a	Dr Torres would ask why!
CD20	Dr Torres would ask why!
CD21	Dr Torres would ask why!
CD23	Dr Torres would ask why!
CD3	Dr Torres would ask why!
CD30	Dr Torres would ask why!
CD31	Dr Torres would ask why!
CD34	Dr Torres would ask why!
CD35	Dr Torres would ask why!
CD4	Dr Torres would ask why!
CD43	Dr Torres would ask why!
CD45 (LCA)	Dr Torres would ask why!
CD5	Dr Torres would ask why!
CD56	Dr Torres would ask why!
CD57	Dr Torres would ask why!
CD68	Dr Torres would ask why!
CD7	Dr Torres would ask why!
CD79a	Dr Torres would ask why!
CD8	Dr Torres would ask why!
CD99	Dr Torres would ask why!
CDX2	Dr Torres would ask why!
CEA-m	Dr Torres would ask why!
Chromogranin	Dr Torres would ask why!

CK17 to Glypican 3

Test	Result
CK17	Dr Torres would ask why!
CK19	Dr Torres would ask why!
CK20	Dr Torres would ask why!
CK34betaE12	Dr Torres would ask why!
CK5/6	Dr Torres would ask why!
CK7	Dr Torres would ask why!
CMV	Dr Torres would ask why!
c-MYC	Dr Torres would ask why!
Cyclin D1	Dr Torres would ask why!
D2-40	Dr Torres would ask why!
Desmin	Dr Torres would ask why!
DOG1	Dr Torres would ask why!
EBV	Dr Torres would ask why!
EMA	Dr Torres would ask why!
ER and PR	Dr Torres would ask why!
Factor VIII	Dr Torres would ask why!
Factor XIIIa	Dr Torres would ask why!
Fascin	Dr Torres would ask why!
FH	Dr Torres would ask why!
FSH	Dr Torres would ask why!
Gastrin	Dr Torres would ask why!
GATA3	Dr Torres would ask why!
GCDFP-15 (BRST2)	Dr Torres would ask why!
GFAP	Dr Torres would ask why!
GH	Dr Torres would ask why!
Glucagon	Dr Torres would ask why!
Glypican-3	Dr Torres would ask why!

HBME-1 to IgM

Test	Result
HBME-1	Dr Torres would ask why!
HBV core	Dr Torres would ask why!
HBV surface	Dr Torres would ask why!
H-caldesmon	Dr Torres would ask why!
HCG	Dr Torres would ask why!
Helicobacter	Dr Torres would ask why!
Hepatocyte	Dr Torres would ask why!
HER2/neu	Dr Torres would ask why!
HHV-8	Dr Torres would ask why!
HMB-45	Dr Torres would ask why!
HNF1beta	Dr Torres would ask why!
HPV	Dr Torres would ask why!
HSV-I	Dr Torres would ask why!
HSV-II	Dr Torres would ask why!
IDH-1	Dr Torres would ask why!
Inhibin	Dr Torres would ask why!
INI1 (BAF47)	Dr Torres would ask why!
Insulin	Dr Torres would ask why!
Kappa	Dr Torres would ask why!
Ki-67	Dr Torres would ask why!
Lambda	Dr Torres would ask why!
Leu 7	Dr Torres would ask why!
IgA	Dr Torres would ask why!
IgG	Dr Torres would ask why!
IgM	Dr Torres would ask why!

LH to PDGFR

Test	Result
LH	Dr Torres would ask why!
LIN28	Dr Torres would ask why!
Lysozyme	Dr Torres would ask why!
mammoglobin	Dr Torres would ask why!
MAP2	Dr Torres would ask why!
MCV	Dr Torres would ask why!
Melanin A	Dr Torres would ask why!
MHC class I	Dr Torres would ask why!
MITF	Dr Torres would ask why!
MUM1	Dr Torres would ask why!
Myeloperoxidase	Dr Torres would ask why!
MYO D1	Dr Torres would ask why!
Myoglobin	Dr Torres would ask why!
Napsin	Dr Torres would ask why!
NF	Dr Torres would ask why!
NKX3.1	Dr Torres would ask why!
NSE	Dr Torres would ask why!
OCT3/4	Dr Torres would ask why!
p16	Dr Torres would ask why!
P501S	Dr Torres would ask why!
p53	Dr Torres would ask why!
p57	Dr Torres would ask why!
p63	Dr Torres would ask why!
Pankeratin	Dr Torres would ask why!
PAX2	Dr Torres would ask why!
PAX5	Dr Torres would ask why!
PAX8	Dr Torres would ask why!
PCNA	Dr Torres would ask why!
PDGFR	Dr Torres would ask why!

PLAP to WT1

Test	Result
PLAP	Dr Torres would ask why!
PNL-2C	Dr Torres would ask why!
Prolactin	Dr Torres would ask why!
PSA	Dr Torres would ask why!
PSAP	Dr Torres would ask why!
RCC	Dr Torres would ask why!
S-100	Dr Torres would ask why!
SALL4	Dr Torres would ask why!
Smooth muscle actin	Dr Torres would ask why!
Somatostatin	Dr Torres would ask why!
STAT6	Dr Torres would ask why!
Synaptophysin	Dr Torres would ask why!
TdT	Dr Torres would ask why!
TFE3	Dr Torres would ask why!
TFEB	Dr Torres would ask why!
Thyroglobulin	Dr Torres would ask why!
Toxoplasma	Dr Torres would ask why!
TSH	Dr Torres would ask why!
TTF-1	Dr Torres would ask why!
Ubiquitin	Dr Torres would ask why!
UCHL1 (PGP9.5)	Dr Torres would ask why!
Ulex Europaeus	Dr Torres would ask why!
Vimentin	Dr Torres would ask why!
VIP	Dr Torres would ask why!
VZV	Dr Torres would ask why!
WT-1	Dr Torres would ask why!

Molecular testing

Chromosomal translocations

Translocations Chr 1-10

Test	Result
t(1;13) PAX7-FKHR	Dr Torres would ask why!
t(2,13) PAX3-FKHR	Dr Torres would ask why!
t(8;14) MYC-IGH	Dr Torres would ask why!
t(9;22) BCR-ABL	Dr Torres would ask why!
t(9;22) CHN-EWS	Dr Torres would ask why!

Translocations Chr 11-13

Test	Result
t(11;14) CCND1-IGH	Dr Torres would ask why!
t(11;22) EWS-WT1	Dr Torres would ask why!
t(11;22) FLI1-EWS	Dr Torres would ask why!
t(12;15) ETV6-NTRK3	Dr Torres would ask why!
t(12;16) FUS-ATF1	Dr Torres would ask why!
t(12;16) CHOP-TLS	Dr Torres would ask why!
t(12;22) EWS-ATF1	Dr Torres would ask why!

Translocations Chr 14-22

Test	Result
t(14,18) IGH-BCL2	Dr Torres would ask why!
t(15;17) PML-RARA	Dr Torres would ask why!
t(16;21) FUS-ERG	Dr Torres would ask why!
t(17;22) COLA1-PDGFB	Dr Torres would ask why!
t(21;22) EWS-ERG	Dr Torres would ask why!

Translocations Chr X & Y

Test	Result
t(X;1) PRCC-TFE3	Dr Torres would ask why!
t(X;17) TFE3-ASPL	Dr Torres would ask why!
t(X;18) SYT-SSX	Dr Torres would ask why!

Other molecular tests

Molecular tests (A-B)

Test	Result
ALK sequencing	Dr Torres would ask why!
B cell clonality Southern / PCR	Dr Torres would ask why!
BCL2 PCR	Dr Torres would ask why!
BRAF sequencing	Dr Torres would ask why!

Molecular tests (C-H)

Test	Result
EBV PCR	Dr Torres would ask why!
EGRF sequencing	Dr Torres would ask why!
H3F3A sequencing	Dr Torres would ask why!
HHV-8 PCR	Dr Torres would ask why!

Molecular tests (I-J)

Test	Result
Identity testing PCR	Dr Torres would ask why!
IDH1/2 PCR	Dr Torres would ask why!
JAK2 V617F ARMS	Dr Torres would ask why!

Molecular tests (K-Z)

Test	Result
KIT sequencing	Dr Torres would ask why!
LOH 1p/19q PCR	Dr Torres would ask why!
T cell clonality Southern / PCR	Dr Torres would ask why!

Diagnosis

LEIOMYOMA WITH TRANEXAMIC ACID ASSOCIATED MICROINFARCTION

This smooth muscle tumor depicts no atypia. When in this situation it is prudent to request detailed clinical history. Clinicians often do not inform of all agents given to patients to control uterine bleeding.^[1]

References

↑ Ip, PP.; Lam, KW.; Cheung, CL.; Yeung, MC.; Pun, TC.; Chan, QK.; Cheung, AN. (Aug 2007). "Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas.". Am J Surg Pathol 31 (8): 1215-24. doi:10.1097/PAS.0b013e318032125e. PMID 17667546.

Other cases

[pmid17667546-1] Ip, PP.; Lam, KW.; Cheung, CL.; Yeung, MC.; Pun, TC.; Chan, QK.; Cheung, AN. (Aug 2007). "Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas.". Am J Surg Pathol 31 (8): 1215-24. doi:10.1097/PAS.0b013e318032125e. PMID 17667546.

[1]

@@ Line 8: / Line 8: @@
 [[Image: Leiomyoma with changes secondary to tranexamic acid treatment low magnification.jpg |500px|link=|center|]]
 <center>Low magnification. [[H&E stain]].</center>
-{{hidden|Intermediate magnification|[[Image: NAME OF IMAGE GOES HERE |500px|link=|center|]]
-<center>Intermediate magnification. [[H&E stain]].</center>}}
 {{hidden|High magnification|[[Image: Leiomyoma with changes secondary to tranexamic acid treatment high magnification.jpg |500px|link=|center|]]
@@ Line 16: / Line 13: @@
 ===Differential diagnosis===
-{{hidden|Differential diagnosis|<center>Smooth muscle tumor of undetermined malignant potential(STUMP), leiomyosarcoma </center>}}
+{{hidden|Differential diagnosis|<center>[[Smooth muscle tumour of uncertain malignant potential]] (STUMP), [[uterine leiomyosarcoma]]</center>}}
 ===Additional tests===
 ====More history====
-{{hidden|More history|<center>Patient had received lysteda for control of bleeding </center>}}
+{{hidden|More history|<center>Patient had received lysteda for control of bleeding.</center>}}
 ====Ask a colleague====
-{{hidden|Ask a colleague|<center>COLLEAGUE'S ADVICE HERE</center>}}
+{{hidden|Ask a colleague|<center>Did you check the history?  I wonder whether this could be drug effect.</center>}}
 ====Stains====
@@ Line 271: / Line 268: @@
 ===Diagnosis===
 {{hidden|Diagnosis|<center>[[uterine leiomyoma|LEIOMYOMA]] WITH TRANEXAMIC ACID ASSOCIATED MICROINFARCTION</center><br>
-This smooth muscle tumor depicts no atypia.  When in this situation it is prudent to request detailed [[clinical history]].  Clinicians often do not inform of all agents given to patients to control uterine bleeding.   <ref>{{Cite journal  | last1 = Ip | first1 = PP. | last2 = Lam | first2 = KW. | last3 = Cheung | first3 = CL. | last4 = Yeung | first4 = MC. | last5 = Pun | first5 = TC. | last6 = Chan | first6 = QK. | last7 = Cheung | first7 = AN. | title = Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas. | journal = Am J Surg Pathol | volume = 31 | issue = 8 | pages = 1215-24 | month = Aug | year = 2007 | doi = 10.1097/PAS.0b013e318032125e | PMID = 17667546 }}</ref>
+This smooth muscle tumor depicts no atypia.  When in this situation it is prudent to request detailed [[clinical history]].  Clinicians often do not inform of all agents given to patients to control uterine bleeding.<ref name=pmid17667546>{{Cite journal  | last1 = Ip | first1 = PP. | last2 = Lam | first2 = KW. | last3 = Cheung | first3 = CL. | last4 = Yeung | first4 = MC. | last5 = Pun | first5 = TC. | last6 = Chan | first6 = QK. | last7 = Cheung | first7 = AN. | title = Tranexamic acid-associated necrosis and intralesional thrombosis of uterine leiomyomas: a clinicopathologic study of 147 cases emphasizing the importance of drug-induced necrosis and early infarcts in leiomyomas. | journal = Am J Surg Pathol | volume = 31 | issue = 8 | pages = 1215-24 | month = Aug | year = 2007 | doi = 10.1097/PAS.0b013e318032125e | PMID = 17667546 }}</ref>
 ===References===
 {{Reflist|1}}
@@ Line 283: / Line 280: @@
 [[Category:Cases]]
-<!-- SELECT A CATEGORY
 [[Category:Cases in gynecologic pathology]]
--->
+[[Category:Cases in gynecologic pathology - fellow and expert]]
 [[Category:Cases difficulty 7]] <!-- difficulty 1-7 -- should roughly correspond to the PGY level -->