Week of Consults and Tumor Board - Week 2

Wow! Another amazing week has passed.
This week we got some usual cases.

First a BST case: 
Clinical history: 56 yo woman with a 2 year history of progressively enlarging mass on left scapula, associated with reduced range of motion and weight loss.  Appears lytic on imaging.

This is a sarcoma with epithelioid features and the differential diagnosis includes epithelioid sarcoma, epithelioid hemangoendothelioma and epithelioid neural neoplasm.  IHC is not available here, since the patients have to pay for it up front and then it is send out to Nairobi. Thank you to the BST team for the virtual consult.

A head and neck case:

Images first, then clinical history:

Clinical history: This is a 58 year old woman with a 35 year history of a neck mass resected twice previously elsewhere. She represents with a 5 cm lesion (below) at the previous resection site and the above polypoid squamous mucosa.

Did your thinking about the first set of images changed based on the second set? The first set of images evokes squamous cell carcinoma in situ, however note that although the nuclei are rather enlarged, the cytoplasm is AMPLE. There is no invasion. We think that this patient may have had radiation for ameloblastoma seen in the second set of images (which may explain the atypical mitoses).  The patient was discussed in tumor board and she has a small recurrence in a "tricky spot" according to her surgeon, but hopefully she will be able to be rid of this "benign" neoplasm that has resulted in a hemimandibulectomy.

Outside of the hospital:
We climbed Mt. Longonot this weekend - in the heat. I was very excited to get back to the starting point.

At the "summit", the highest point around the crater.

We were greeted by giraffes on our return to the base of the mountain.

Acacia tree with bulbs at the base of long thorns, where the ants await to attack giraffes.

Closer to home:

We were out on a short hike and passed a farm that sells "sukuma wiki", a green which is very popular here. Dr. Garcia is making sure that I have sufficient iron stores. 

We were joined by the local pathologist, Rosemary!

Answer to last week's gross case:

The middle of the first picture had a smooth, off-white nodule in the center corresponding to this focus of cartilage.

The center of the second picture had a soft "brainy" looking bit, immature neural tissue.

The important lesson for me was that this was a LARGE tumor (~20 cm). The first 6 slides submitted had only mature neural tissue!  Dr. Garcia went back and resampled, another 8 cassettes, and the majority had some immature component.  Large teratomas are almost always immature!

New gross case:

Clinical history: 56 year old woman with a progressive fungating mass on dorsum toe of left hallux fossa for one year.

This was grossed today, so we all have to wait to find out more! (There is a previous biopsy, but I'm not telling...heehee)

Until next time, Angelica