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FEBRIARY RADIO-SURGERY-PATHO CONFERENCE [Autosaved].pptx
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- 2. Objectives ● Correlate radiologyand surgical findings with histopathology result ● Relate radiologic and surgical findings to patient’s clinical progress or outcomes ● Strengthen interdisciplinary collaboration 2
- 3. A.C. 44/M LEFTRENAL MASS D.A. 38/F PARAMEDIAN ISTHMUS MASS J.B. 40/F INVASIVE DUCTAL CARCINOMA CASES
- 4. A. C. 44/M LEFTRENAL MASS
- 5. HISTORY ● Diagnosed caseof rectal adenocarcinoma ● S/P Laparotomy ● CT scan showed: Enhancing mass at the left mid cortex of the kidney ● Advised UTZ guided biopsy of the left renal mass. HPI : 5
- 6. HISTORY ● BP: 140/90 ●HR: 95 ● RR: 20 ● TEMP:36 Day of Admission 6 Hospital Day 1 ● S/P UTZ GUIDED BIOPSY OF LEFT RENAL MASS
- 7. A. C. 44/MLEFT RENAL MASS CT SCAN REPORT
- 8. Neoplasm with ClearCell Renal Features HISTOPATHOLOGY REPORT
- 9. SUMMARY ● Identifying alarge, irregular mass with features suspicious for malignancy, led to the decision to perform a biopsy. ● The biopsy results, shows classic clear cell histologic appearance of a renal clear cell carcinoma: neoplastic cells have clear cytoplasm and arranged in nests with intervening blood vessels. 9
- 10. D. A. 38/F Paramedian Isthmus Mass
- 11. HISTORY ● Noted palpableright anterior neck mass with associated globus sensation. HPI: 11
- 12. OUTPATIENT ● BP: 110/70 ●HR: 75 ● RR: 18 ● Temp: 36.7 V/S: PE: ● HEENT: Right anterior neck mass, immobile, hard.
- 13. NECK ULTRASOUND Right paramedian:Solid, hypoechoic, lobulated, ovoid nodule measuring 2.0 x 1.1 x 1.8 cm Left paramedian: spongiform, isoechoic, ovoid, smooth measuring 0.5 x 0.3 cm
- 14. RIGHT PARAMEDIAN ISTHMUS MASS:SUSPICIOUS FOR PAPILLARY THYROID CARCINOMA WITH ONCOCYTIC CHANGES HISTOPATHOLOGY REPORT
- 15. J.B. 40/F INVASIVE DUCTALCARCINOMA
- 16. HISTORY ● Enlarging massat the right breast; erythematous and eczematous changes of both breasts; No immediate family history of breast cancer. 16
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Editor's Notes
- #1 Good evening doctors I am Michael James Vano, 2nd year radiology resident and welcome to our 2nd radio-surgery patho conference
- #2 Correlate radiology and surgical findings with histopathology result for comprehensive diagnostic confirmation Relate radiologic and surgical findings to patient’s clinical progress or outcomes to assess diagnostic effectiveness and treatment alignment Strengthen interdisciplinary collaboration to enhance patient care and promote holistic teamwork within the healthcare system
- #7 A fairly defined heterogeneously enhancing mass with washout in the porto venous phase is noted in the left mid cortex measuring approximately 2.9 x 1.6 x 2.5 cm (L x W x AP). IMPERSSION: FAIRLY DEFINED HETEROGENEOUSLY ENHANCING MASS IN THE LEFT MIDCORTEX, CONSIDER NEOPLASTIC PROCESS
- #8 On hospital day 1, an Ultrasound-guided left renal mass biopsy was performed. Histopathology Findings: Primary consideration is Clear Cell Renal Cell Carcinoma This is the classic clear cell histologic appearance of a renal cell carcinoma: the neoplastic cells have clear cytoplasm and are arranged in nests with intervening blood vessels. This microscopic appearance is why they are often called "clear cell carcinomas". Mutation of the VHL gene may be found.
- #9 Radiologists helped identify A fairly defined heterogeneously enhancing mass in the left mid cortex with features suspicious for neoplastic process, which led to the decision to perform a biopsy. The biopsy results, shows classic clear cell histologic appearance of a renal cell carcinoma: the neoplastic cells have clear cytoplasm and are arranged in nests with intervening blood vessels. Renal cell carcinoma (RCC) is malignant, which means it is a type of cancer that can grow and spread to other parts of the body. Unlike benign tumors, which do not spread and are usually less harmful, malignant tumors like RCC can invade nearby tissues and metastasize to distant organs Renal clear cell carcinoma (RCC) has several distinctive radiological characteristics when viewed on a CT scan: Exophytic Appearance: The tumor often appears to grow outward from the kidney. Enhancement Patterns: Clear cell RCC typically shows a greater degree of enhancement during the corticomedullary and nephrographic phases of multiphasic CT scans compared to other types of renal cell carcinoma, such as papillary RCC. Heterogeneous Appearance: The tumor often has a heterogeneous appearance due to the presence of multiple areas of internal necrosis, cystic changes, or hemorrhage. Calcifications: Some tumors may show curvilinear calcifications. Vascularity: Clear cell RCC is highly vascular, which can be seen as increased blood flow within the tumor on imaging. Renal clear cell carcinoma (RCC) typically does not show washout during the portal venous phase. Instead, it often demonstrates significant enhancement during the corticomedullary phase and retains this enhancement into the nephrogenic phase
- #10 This is a case of a 72-year-old female
- #13 TR4: At least 1, right paramedian, solid, hypoechoic, lobulated, ovoid measuring 2.0 x 1.1 x 1.8 cm with intralesional vascularity of doppler evaluation. TR1: At least 1, left paramedian, spongiform, isoechoic, ovoid, smooth measuring 0.5 x 0.3 cm. IMPRESSION: Prominent isthmus due small benign-looking nodule in the left paramedian isthmus and a moderately suspicious solid nodule in the right paramedian isthmus. Correlation is suggested.
- #14 Ultrasound-guided fnab was performed. Histopathology Findings: Suspicious for papillary thyroid carcinoma with oncocytic changes. Figure Oncocytic follicular variant papillary thyroid carcinoma. These tumors are oncocytic follicular cell-derived neoplasms that exhibit exclusive follicular architecture along with nuclear features of papillary thyroid carcinomas in the absence of classic architecture, solid growth (>30%), tumor necrosis or increased mitotic activity. The nuclear alterations of papillary thyroid carcinoma are characterized by nuclear membrane irregularities in enlarged nuclei. The inset illustrates an intranuclear pseudoinclusion.
- #16 who presented with a 3-day history of absent bowel movements and flatus, without prior medical consultation.
- #17 Enlarging lobulated right breast mass with areas of necrosis. Surrounding erythema and eczematous changes are noted in both breasts
- #18 RIGHT BREAST There is a mass in with the following location, measurement and characteristics: • 12:00 to 3:00 positions (upper inner quadrant) measuring approximately ~ 6.5 x 5.7 x 6.0 cm, irregular, hypoechoic with indistinct margins, associated punctate echogenic foci, nipple-areola skin thickening as well as obliteration of the nipple (palpable) LEFT BREAST • No mass/lesion with prominent skin (<3 mm) ASSESSMENT: 1. IRREGULAR SOLID MASS WITH INDISTINCT MARGINS, ASSOCIATED INTRALESIONAL MICROCALCIFICATIONS, NIPPLE OBLITERATION AND SKIN THICKENING , RIGHT BREAST 2. BILATERAL AXILLARY LYMPHADENOPATHY 3. PROMINENT SKIN, LEFT NIPPLE AREOLA. CONCERNING FOR EARLY /BEGINNING MANIFESTATION OF MALIGNANCY CONFINED TO THE SKIN RECOMMENDATIONS: > BIOPSY SHOULD BE PERFORMED IN THE ABSENCE OF CLINICAL CONTRAINDICATION (RIGHT BREAST AND BOTH AXILLAE) >SKIN BIOPSY/SMEAR OF THE LEFT BREAST NIPPLE AREOLA COMPLEX
- #19 There are axillary lymph nodes bilaterally with thickened cortexes and obliterated hila ranging 1.4 to 2.1 cm. ASSESSMENT: 2. BILATERAL AXILLARY LYMPHADENOPATHY 3. PROMINENT SKIN, LEFT NIPPLE AREOLA. CONCERNING FOR EARLY /BEGINNING MANIFESTATION OF MALIGNANCY CONFINED TO THE SKIN RECOMMENDATIONS: > BIOPSY SHOULD BE PERFORMED IN THE ABSENCE OF CLINICAL CONTRAINDICATION (RIGHT BREAST AND BOTH AXILLAE) >SKIN BIOPSY/SMEAR OF THE LEFT BREAST NIPPLE AREOLA COMPLEX
- #20 There are axillary lymph nodes bilaterally with thickened cortexes and obliterated hila ranging 1.4 to 2.1 cm. ASSESSMENT: 2. BILATERAL AXILLARY LYMPHADENOPATHY 3. PROMINENT SKIN, LEFT NIPPLE AREOLA. CONCERNING FOR EARLY /BEGINNING MANIFESTATION OF MALIGNANCY CONFINED TO THE SKIN RECOMMENDATIONS: > BIOPSY SHOULD BE PERFORMED IN THE ABSENCE OF CLINICAL CONTRAINDICATION (RIGHT BREAST AND BOTH AXILLAE) >SKIN BIOPSY/SMEAR OF THE LEFT BREAST NIPPLE AREOLA COMPLEX
- #21 Craniocaudal and mediolateral oblique 3D mammography with 2D reconstructed views of both breasts. These are baseline mammograms. The breasts are heterogeneously dense which obscure small masses. There is an irregular high density mass located at mid to posterior right upper inner quadrant measuring approximately ~8.1 x 4.6 cm. Associated with intralesional fine pleomorphic microcalcifications, subtle nipple retraction and skin thickening. This corresponds the clinically palpable concern. Skin calcifications in both breasts. Prominent skin in the left nipple areola 0.28 mm (normal 0.2 cm) Dense axillary lymph nodes largest up to 2.0 cm on the right. ASSESSMENT: 1. IRREGULAR HIGH DENSITY MASS WITH INDISTINCT MARGINS, INTRALESIONAL FINE PLEOMORPHIC MICROCALCIFICATIONS, SUBTLE NIPPLE RETRACTION AND SKIN THICKENING, RIGHT BREAST 2. BILATERAL AXILLARY LYMPHADENOPATHY 3. SKIN CALCIFICATIONS, BOTH BREASTS 4. PROMINENT SKIN, LEFT BREAST. CONCERNING FOR EARLY /BEGINNING MANIFESTATION OF MALIGNANCY CONFINED TO THE SKIN BIRADS CATEGORY: 5- HIGHLY SUGGESTIVE OF MALIGNANCY RECOMMENDATIONS: > BIOPSY SHOULD BE PERFORMED IN THE ABSENCE OF CLINICAL CONTRAINDICATION (RIGHT BREAST AND BOTH AXILLAE) >SKIN BIOPSY/SMEAR OF THE LEFT BREAST
- #23 MICROSCOPIC DESCRIPTION Microscopic examination of the slide labelled "Right breast mass" shows a malignant process composed of pleomorphic ductal cells that are disposed in cords and interconnecting trabeculae. These cells insinuate the stroma, accompanied by a desmoplastic stromal reaction. The tumor cells possess large irregular nuclei with coarse chromatin and visible nucleoli. There is increased mitotic activity Sections of the right and left nipple areola complex show similar findings. They exhibit an acanthotic type of stratified squamous epithelium. The underlying stroma exhibits a dense lymphocytic infiltration with some seen occupying small vascular vessels. No evidence of malignancy or atypical cell seen. Right breast mass :- INVASIVE DUCTAL CARCINOMA, NUCLEAR GRADE-2. IMAGE: INFILTRATIVE SMALL NESTS AND OCCASIONAL TUBULES OF TUMOR CELLS WITH MODERATELY ENLARGED NUCLEI WITHIN PROMINENT DESMOPLASTIC STROMA Right nipple areola complex:- SKIN TISSUE WITH ACANTHOSIS AND LYMPHOCYTIC VASCULITS. NEGATIVE FOR MALIGNANCY Left nipple areola complex:- SKIN TISSUE WITH ACANTHOSIS AND LYMPHOCYTIC VASCULITS. NEGATIVE FOR MALIGNANCY MICROSCOPIC DESCRIPTION (LEFT AXILLARY NODE) Microscopic examination show sheets and clusters of mature adipocytes with a background of mononuclear lymphocytic inflammatory cells. No atypical cells are seen. Left axillary node: FIBROFATTY TISSUE WITH CHRONIC INFLAMMATION. NO ATYPICAL CELLS SEEN MICROSCOPIC DESCRIPTION ( RIGHT AXILLARY NODE) Microscopy show sheets and clusters of mature adipocytes with a background of mononuclear lymphocytic inflammatory cells. No atypical cells are seen. Right axillary node: FIBROFATTY TISSUE WITH CHRONIC INFLAMMATION. NO ATYPICAL CELLS SEEN
- #24 Overall, the integration of radiology, surgery, and pathology in diagnosing and treating this case offers rich content for a conference focused on the collaboration between specialties. It underlines the importance of cross-specialty communication, particularly when the clinical presentation is atypical or complicated by rare causes.