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EQA

National Musculoskeletal Pathology (NMSP) EQA Scheme Circulation B22






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Images for Bone Cases - Circulation B22  pdf document symbol

Circulation B22 - B31

Female 60 years

Large mass involving acetabulum. Staging negative.

Specimen type: Hemipelvectomy.



Macroscopic description:
Intramedullary tumour (110x8065mm). See photo.

Immunohistochemistry:
Patchily positive for Melan A and SMA. Negative for CKs, desmin, S100, CD138, HMB45, CD34, TFE3, CD117, CD45 and STAT6.


H&E 530496


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Circulation B22 - B32

Male 36 years

Destructive tumour in right proximal tibia.

Specimen type: Right proximal tibia replacement.



Macroscopic description:
Intramedullary tumour (70x60mm). See photo.

Immunohistochemistry:
Positive: H3-3 G34W (patchy) Negative: CKs, SMA, desmin, S100.


H&E 530497


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Circulation B22 - B33

Female 31 years

Destructive mass in right femur. Staging negative.

Specimen type: Right total femurectomy.



Macroscopic description:
Intramedullary tumour with circumferential soft tissue invasion (240x75x95mm). See photo.

Immunohistochemistry:
FISH: EWSR1 positive. RNA based NGS: non-ETS fusion partner detected.


H&E 530498


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Circulation B22 - B34

Female 19 years

Intramedullary lesion in left femur. See Imaging. Radiological differential diagnosis: Abscess, LCH.

Specimen type: Open biopsy.



Macroscopic description:
Biopsy only (See imaging on PDF).

Immunohistochemistry:
Positive for S100 and CD68. Negative for CD1a, SOX10, HMB45.


H&E 530499


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Circulation B22 - B35

Male 37 years

Hind quarter amputation for tumour in left anterior pelvis and proximal thigh. Enlarged inguinal lymph nodes.

Specimen type: Hind quarter amputation.



Macroscopic description:
Hind quarter amputation.


H&E 530500


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Circulation B22 - B36

Male 28 years

Mass distal femoral diaphysis.

Specimen type: Core biopsy.



Macroscopic description:
Core biopsy.

Molecular genetic studies: MDM2 gene amplification detected by interphase FISH.


H&E 530501


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Circulation B22 - B37

Male 36 years

Sacrococcygeal mass detected on staging CT for lymphoma.

Specimen type: Core biopsy.



Macroscopic description:
3 cores of tissue 15mm, 5mm & 5mm in length.

Immunohistochemistry:
Positive for MNF116 and brachyury with retention of INI-1 expression.


H&E 530521


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Circulation B22 - B38

Male 58 years

Anterior knee pain. Lesion at proximal tibia, ?pathological.

Specimen type: Biopsy.



Macroscopic description:
Gritty fragments 30x20x5mm in aggregate.


H&E 530503


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Circulation B22 - B39

Female 23 years

Lesion in occipital bone, 5cm. Incidental finding ?fibrous dysplasia.

Specimen type: Resection.



Macroscopic description:
Part of occipital bone 50x50x20mm, thickened with ill defined lesion within the entire specimen.

Immunohistochemistry:
MDM2 gene amplification detected. GNAS wild type in hot spots.


H&E 530504


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Circulation B22 - B40

Female 18 years

Tumour right distal tibia.

Specimen type: Curratage.



Macroscopic description:
Fragmented soft tissue 90x55x15mm.


H&E 530505


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Circulation B22 - ST31

Female 59 years

Left supraclavicular soft tissue lesion.

Specimen type: Excision.



Macroscopic description:
Fibrofatty tissue 75 x 42 x 45 mm. Sectioning reveals pale firm tumour 35 x 34 x 50 mm.

Immunohistochemistry:
MUC4 positive.


H&E 530506


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Circulation B22 - ST32

Male 38 years

Subcutaneous periarticular lesion, cuboidal fossa.

Specimen type: Excision.



Macroscopic description:
3 cm well circumscribed mucoid lesion.

Immunohistochemistry:
None provided.


H&E 530507


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Circulation B22 - ST33

Female 74 years

Right lateral distal thigh mass-growing slowly over 18 to 24 months. Clinically superficial.

Specimen type: Excision.



Macroscopic description:
An encapsulated mass 21 x 12 x 10 mm.

Immunohistochemistry:
Positive for SMA. Negative for EMA, S100, AE1/3. CD34 highlights the endothelial cells.


H&E 530508


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Circulation B22 - ST34

Male 47 years

Large lipomatous mass left back ?Sarcoma.

Specimen type: Resection.



Macroscopic description:
Lobulated encapsulated fatty mass 105 x 75 x 30 mm. Cuts surface is homogeneously fatty. No necrosis or solid areas.

Immunohistochemistry:
CD34 not expressed.


H&E 530509


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Circulation B22 - ST35

Female 47 years

Massive intrathoracic fatty mass ? Sarcoma.

Specimen type: Excision.



Macroscopic description:
Lobulated encapsulated fatty mass, 302 x 190 x 65 mm. No solid, haemorrhagic or necrotic areas.

Immunohistochemistry:
FISH studies showed no evidence of MDM2 gene amplification.


H&E 530510


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Circulation B22 - ST36

Female 53 years

Mass left subscapular area. Symptomatic - clicking.

Specimen type: Excision.



Macroscopic description:
Excision biopsy 35mm.

Immunohistochemistry:
Elastic stain supplied (530512.svs).


Circulation B22 - ST37

Female 65 years

Soft tissue lesion left lower medial thigh.

Specimen type: Excision.



Macroscopic description:
2 cm circumscribed lobulated haemorrhagic tumour within subcutaneous fat.

Immunohistochemistry:
Positive for Desmin. Negative for SMA, AE1/3, S100, caldesmon, STAT6, TLE1.

FISH studies on previous biopsy showed EWSR1 rearrangement.


H&E 530513


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Circulation B22 - ST38

Male 30 years

? Giant cell tumour of tendon sheath left middle finger, not connected to bone.

Specimen type: Excision.



Macroscopic description:
An intact pearly cream mass, 32 x 30 x 22 mm.


H&E 530514


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Circulation B22 - ST39

Female 29 years

Retroperitoneal mass.

Specimen type: Excision.



Macroscopic description:
Large partly necrotic mass.


H&E 530515


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Circulation B22 - ST40

Male 53 years

Long-standing circumscribed mass medial right ankle.

Specimen type: Excision.



Macroscopic description:
A smooth surfaced nodule 35 x 20 x 20 mm.

Immunohistochemistry:
Positive for S100 and desmin (focal). Negative for AE1/3, SMA and MUC4.


H&E 530516


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