The document outlines a meeting for the South East England General Histopathology EQA Scheme held on November 30, 2022, covering case discussions and preliminary score reviews of various specimens. The agenda included introductions, a review of cases 865-874, and discussions on merging decisions based on participant responses. Participants were reminded of the meeting's educational purpose and the process for providing feedback and earning CPD points.

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

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Meeting Etiquette
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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. Case Consultation
• 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 im
age
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.
The main tan
nodule measures
55x48x37mm
(not included in
the slide).
Incidental finding
(lesion not seen
grossly).
TTF-1(+),
Thyroglobulin (+),
HBME-1 (-),
Calcitonin (-), DPAS
stain:
Positive
intratrabecular
hyalin
Click her
e to vie
w digita
l 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
This will
give xx%
agreement

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 im
age
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 di
gital imag
e
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 t
o view digit
al 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 t
o view digit
al 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 i
mage
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 im
age
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 her
e to vie
w digita
l 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.
Negative: CD30, EBER-
ISH, AE1/AE3. No light
chain restriction.
Click here to
view digital i
mage
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.
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 i
mage
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 Imag
e A1
Digital Imag
e A2
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

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