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Criteria: ENDO Found: 45 cases
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Case 1 - ecp25, Endocrine Pathology
Presented by: Yersu Kapran, Istanbul, Turkey

37 year old male patient complained of dyspepsia and dysphagia. His upper gastrointestinal endoscopy revealed a polypoid mass lesion at GEJ . After the diagnosis of poorly differantiated carcinoma, total gastrectomy was performed. Tumor was 5 cm in greatest diameter and located at GEJ. Neoplastic cells had hyperchromatic nuclei with scant cytoplasm, and high mitotic rate. Immunophenotypic analysis revealed strong and diffuse synaphtopysin and CD56 posititivity. The case was sent for second opinion.
Slide 1SYN (1)SYN (2)CD56
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Case 2 - ecp25, Endocrine Pathology
Presented by: Jerome Cros, Clichy, France

A 60 years old female with no medical history presents a pancreatic tail mass and a multinodulary liver. The (US)-guided core biopsy of one of the liver lesions is performed.
Slide 1
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Case 3 - ecp25, Endocrine Pathology
Presented by: Catarina Eloy, Porto, Portugal

Fifty-six year old woman with clinical and cytological diagnosis of Hashimoto thyroiditis (thyroid peroxidase antibodies >1000 IU/ml) that presented with a painless nodule in the left lobe of the thyroid measuring 25mm in its largest dimension, documented in the neck ultrasound. This nodule was “cold” in the scintigraphy with radioactive iodine.

Macroscopically, the thyroid had a pale, vaguely nodular appearance. An encapsulated nodule measuring 25mm x 25mm x 17mm was present in the upper half of the left lobe.This nodule had a solid, brownish, variegated cut surface. In the lower half of the right lobe there was a solid, whitish nodule measuring 3mm in its largest dimension.
Slide 1
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Case 4 - ecp25, Endocrine Pathology
Presented by: Frederique TISSIER, Paris, France

63-year old man with an adrenal nodule considered as an incidentaloma. There was no hormonal biological abnormality. Computed tomography (CT) imaging showed an adrenal mass (14 mm in 2007, 18 mm in 2008, 18 mm in 2009) with an unenhanced density of 25 Hounsfield units and a washout, suggesting a benign lesion. In September 2010, CT imaging showed an increase of the mass (25 mm). In January 2011, positron emission tomography scanning with 18 F-fluorodeoxyglucose was in favor of a benign lesion but could not rule out a malignant one. In July 2011, CT imaging showed a further increase of the mass (30 mm). An adrenalectomy was decided. At gross examination, the adrenal weighed 12g and showed a lesion measuring 34 x 25 x 15mm, yellow orange, with hemorrhagic areas.
Slide 1
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Case 5 - ecp25, Endocrine Pathology
Presented by: Ronald R. de Krijger, Delft, Netherlands

63-year old woman with unremarkable previous clinical history, presented with an enlarged left ovary, maximum diameter 4 cm. At gross inspection a fallopian tube was present with a length of 4 cm. The ovary measured 4x2,5x2 cm. Upon sectioning hairs and debris were noted in a cystic structure.
Slide 1
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Case 6 - ecp25, Endocrine Pathology
Presented by: Paul Komminoth, CH-8063 Z├╝rich, Switzerland

74 year old male patient with a rectal tumor and liver metastases.
Slide 1Makro 1Makro 2Mikro 1 (HE)Mikro 2 (HE)Mikro 3 (HE)Mikro 4 (HE)
Mikro 5 (MiB1)
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Case 7 - ecp25, Endocrine Pathology
Presented by: Prof. Dr. Abbas Agaimy, Erlangen, Germany

A 57-year old man was diagnosed with squamous cell carcinoma (SCC) of the right tonsil at a peripheral hospital and then came to our hospital for further surgical treatment. Right-sided tonsillectomy and synchronous ipsilateral neck dissection (cN+) were performed.
Slide 1Slide 2
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Case 1 - ecp24, Endocrine Pathology
Presented by: Ales Ryska, Hradec Kralove, Czech Republic

A 63-year-old female with a palpable nodule in the right thyroid lobe, having 50 mm in largest diameter at the ultrasound examination. FNAC was performed, the result was: malignancy, most probably papillary carcinoma, metastasis from other source cannot be ruled out. Patient was operated on, the total thyroidectomy was performed. Grossly, in the right lobe (85x60x47 mm, 116 g) a 50 mm solid white homogenous encapsulated spheric tumour was identified. The surrounding gland as well as the contralateral lobe were homogenous, free of tumor.
Virtual slideTTF1ThyroglobulinKi67
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Case 2 - ecp24, Endocrine Pathology
Presented by: Manju Prasad, New Haven, United States

A 26 year-old woman presented with constant dull left-sided flank pain for three days. Ultrasound revealed a 11.3 x 10 x 5.2 cm retroperitoneal left adrenal mass with mixed echogenicity and internal vascularity, and a 9 x 2.2 cm echogenic oval thrombus in the inferior vena cava. CT scan demonstrated a heterogeneously enhancing mass with central area of necrosis and a thrombus extending into the left adrenal vein, renal vein and inferior vena cava. The patient’s plasma metanephrines, aldosterone and renin levels were within normal limits. Staging work up (chest CT, bone scan, bone marrow aspirate and biopsy) did not reveal any metastasis. A left adrenalectomy with inferior vena cava thrombectomy, left nephrectomy and splenectomy was performed.
Slide 1Cut surface of tumor and kidney
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Case 3 - ecp24, Endocrine Pathology
Presented by: Esther Diana Rossi, Rome, Italy

Thyroid follicular patterned lesions are a common finding in general population. A preoperative cytological diagnosis and the definition of the correct management are essential/crucial for avoiding a therapeutical mismanagement. Conventional cytology (CC) has been the cornerstone of thyroid lesions for many years with most important drawbacks represented by: a) the unpredictable rate of inadequate samples and b) the diagnostic difficulties, among the group of follicular proliferation. In 1996 Liquid Based Cytology (LBC), has gained popularity as a new technique for collection and preparation of cytologic specimens also in fine-needle cytology (FNC) with good results and several positive aspects in term of cost-effectiveness, time-sparing and in the application of ancillary techniques such as ICC and molecular biology. The present case faces with a problematic follicular patterned lesion diagnosed on LBC with histological control.

In 2005, a 50-year-old woman underwent FNC, for a 2 cm vascular right nodule which was diagnosed as “follicular proliferation with oxyfilic features”. In 2010, the patient underwent a second FNAB with LBC, on the same nodule, which resulted slightly increased in size. The latter cytological diagnosis pointed out some groups of follicular cells with spindle features and focal nuclear pleomorphisms. The cyto-block slides, obtained from the material stored in the preservative LBC solution, were investigated for immunocytochemistry, underlining a positive expression of thyroglobulin, TTF-1 and MIB-1 whereas negativity of HBME-1, Galectin-3 and Calcitonin. The conclusion led to a well differentiated thyroid neoplastic proliferation with spindle features. One month later, the patient underwent a total thyroidectomy, showing a 1.6 cm capsulated nodule. The lesion was characterized by trabecular structures with cylindrical-ovoid nuclei and eosinophilic granular cytoplasm. The cells were positive for thyroglobulin, TTF-1, focal MIB-1 and S-100 whereas negative for HBME-1, Galectin 3, Calcitonin and b-Catenin.
Slide 1slide2Slide 3Slide 3ecp24_rossi5ecp24_rossi6ecp24_rossi7
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