Case 21

./files/path/files/%D8%B9%D9%84%D9%84_%D9%87%DB%8C%D9%BE%D9%88%D9%86%D8%A7%D8%AA%D8%B1%D9%85%DB%8C_%DA%A9%D8%A7%D8%B0%D8%A8_%DA%86%DB%8C%D8%B3%D8%AA.docx

----------------------------------------------------------------------------------------------------------------------

Case 20

  

----------------------------------------------------------------------------------------------------------------------

Case 19

 خانم 65 ساله با سابقه هیپرتانسیون، هیپوتیرییدیسم و استیوآرتریت که از 3 سال گذشته با توده تیبیای راست مراجعه کرد. در Xray ضایعه expansile در پروگزیمال تیبیای راست مشاهده گردید. در PET/CT ندولهای اینترامدولری هیپرمتابولیک دیده شد. بیوپسی استخوان به عمل آمد:

تصویر1:
./files/path/files/case-18-fig-1.jpg

تصویر 2:
./files/path/files/case-18-fig-2.jpg      

تصویر 3:
./files/path/files/case-18-fig-4.jpg     

تصویر 4:
./files/path/files/case-18-fig-5.jpg   

رنگ آمیزی IHC برای S100 می باشد.
محتملترین تشخیص کدام است؟
چه رنگ آمیزیهایی را برای تشخیص پیشنهاد می کنید؟
----------------------------------------------------------------------------------------------------------------------
 
----------------------------------------------------------------------------------------------------------------------
 Case 15
A 70 years old man with upper liplesion
 
./files/path/files/LIP_12_(2).jpg 

./files/path/files/LIP_12_(1).jpg

----------------------------------------------------------------------------------------------------------------------
 
Case 14
A 72 years old woman with abdominal pain 
Images :
 
 
----------------------------------------------------------------------------------------------------------------------
Case 13
جهت ارزیابی Detection limit یک آنالیت هورمونی؛20 نمونه zero sample  را آزموده ایم. با فرض توزیع نرمال؛ نتایج میانگین 003/0 و ضریب تغییرات 001/0 بدست آمد.Limit of detection   یا LOD  را حساب کنید.
 
 
----------------------------------------------------------------------------------------------------------------------
Case 9
----------------------------------------------------------------------------------------------------------------------

Case 10 
----------------------------------------------------------------------------------------------------------------------

Case 11 
----------------------------------------------------------------------------------------------------------------------

Case 12
----------------------------------------------------------------------------------------------------------------------
Case 7 
 A 60 y/o man with facial skin mass.This patient had involvement of almost the entire face by an extensively ulcerated neoplasm.  
 
Images:./files/path/images/download.jpg./files/path/images/download_




(1).jpg


./files/path/images/download_(2).jpg


./files/path/images/download_(3).jpg



./files/path/images/download_(4).jpg

./files/path/images/download_(5).jpg


- What is key point in histopathology  ? 
 - What is main histopathologic differential diagnosis ?
- What is main IHC findings ?    
- What is final diagnosis ?
Case7پاسخ 
 
 Dx : Mercke cell carcinoma
Histology : Nodules and sheets of round blue cells occupy the
dermis and may extend into subcutaneous  fat
• Trabecular growth pattern occasionally seen
• Spindled cell variant
• Rare epidermotropism( focal or extensive intraepidermal
pagetoid spread )
• The cytoplasm is scanty but visible as a thin acidophilic rim; the
nuclei are round and vesicular, with a typically fine granular (“dusty”)
chromatin and multiple nucleoli
• Mitotic figures and fragmented
nuclei (probably as the result of apoptosis) are plentiful
IHC:
• Cytokeratin 20 positive (perinuclear dot like  pattern)
• low-molecular-weight keratin, positive
• Neurofilament, NSE positive
• Chromogranin, synaptophysin positive
• Cytokeratin 7 usually negative
• Thyroid transcription factor-1 negative
• Leukocyte common antigen negative
Main differential diagnoses:
• Metastatic neuroendocrine carcinoma (e.g., lung primary)
• Lymphoma
•Small cell melanoma
 
----------------------------------------------------------------------------------------------------------------------
Case 8 
A 70 y/o man with bone pain, anemia, increased serum Ca level and increased serum Cr level.    

Bone marrow aspiration :

./files/path/images/Picture1.jpg



- What is diagnosis ?

- What is immunophenotype ?
Case8پاسخ
DX:  - Plasma cell myeloma


 Immunophenotype:
               - Expression of CD38 and CD138
                 -loss of CD19 expression
                 -Absence of CD20
                - Abnormal acquisition of CD56 and often CD117
----------------------------------------------------------------------------------------------------------------------
Case 5
 A 52 y/o man with pancreatic mass
:Images













 



?What is your first diagnosis
 
 ?What is the differential diagnosis 

 ?What IHC stainings do you recommend 

Case5پاسخ
 Intraductal papillary mucinous neoplasm-
 Muconous cystic neoplasm-
- Inhibin and PR : negative in  Intraductal papillary mucinous neoplasm but positive in  Muconous cystic neoplasm.
----------------------------------------------------------------------------------------------------------------------
Case 6

میدانیم کهInter individual CV      Individual index=Intra individual CV/میباشد.چنانکه این Index  برای TG= 0.51 و برای GLU=0.66  باشد در تفسیر این نتایج چه نکته ای باید مد نظر قرار گیرد؟

Case6پاسخ

در تری گلیسیرید چون اندکس کمتر از 0.6 است بهتر است جواب بیمار با خودش مقایسه شود (با جوابهای قبلی) ولی در مورد گلوکز چنین نیست           
---------------------------------------------------------------------------------------------------------------------- 
Case 3

 40 Y/O man bone marrow aspiration : 

Images:
 ?What is your diagnosi
?What is the type of staining
 ?What flow cytometry markers do you recommend for definite diagnosis
 
Case3پاسخ

- Acute Myeloid Leukemia 
- MPO
- CD34,CD133,CD33,CD64,CD16, HLA-12
 
---------------------------------------------------------------------------------------------------------------------- 
Case 4

تعداد 40 نمونه BUN سرم توسط دو روش اندازه گیری شده است.فرمول رگرسیون خطی به شرح زیر است:

Y: 0.9 x- 0.3
Low control:  mean:  14.2 , SD: 1.24
High control:   mean:  48.6 , SD: 1.12
Case4پاسخ
Total error=bias + 2SD
 .از آنجا که غلظت 50 میلی گرم در دسی لیتردر high control  قرار میگیرد؛ SD  این گروه مورد استفاده قرار میگیرد
Y= 0.9x 50- 0.3= 44.7
Bias=50- 44.7/50= 10.6
Total error= 10.6+2x1.12= 12.84
 
---------------------------------------------------------------------------------------------------------------------- 

Case 1

A 34-year-old male patient was admitted to the nephrology service due to a 30-day history of macroscopic hematuria episodes. On physical examination, there were no clinical changes. There was no previous history of relevant disease. On laboratory investigation, glucose, hemoglobin, erythrocytes, creatinine, urea, liver enzymes, and cholesterol were within normal plasma levels. Serologic tests for hepatitis B virus, hepatitis C, and HIV were negative. Qualitative urinalysis revealed the presence of several red blood cells per field. Abdominal computed tomography/ magnetic resonance imaging (CT/MRI) showed an small round lesion affecting the inferior pole of the right kidney. CT/ MRI of the chest has not identified significant alterations.The patient underwent partial nephrectomy.

Gross image: 

Histopathology images:

 

 

 

 

 

 

 


 

 

   What is your diagnosis ?

  What IHC staining do you recommend?
  What is the most proper way to describe this tumor ?

A. Large hemorrhagic tumor of renal medulla
B. Encapsulated multiloculated cystic and solid mass
C. Honeycomb-like yellow tumor
D. Well circumscribed mass with spongy or bubblewrap appearance

Case1پاسخ

-Tubulocystic renal cell carcinoma-
-   PAX8,CK7,CD10,AMACR,Fumarate hydratase, focal positive for HMWK, Negative for ER and PR 
-   D 

---------------------------------------------------------------------------------------------------------------------- 
Case 2

  In the following Levey-Jenning control chart for Cholestrol in 2 levels,in which day the run should be rejected?


Case2پاسخ

 Day 5. The value for Control 1 exceeds a -3s control limit, which is a good indication that there is a problem with the method. Stop, reject the run 
  trouble-shoot the method, fix the cause of the problem, then restart the method and reanalyze the patient specimens
Day 8. Both the values for Control 1 and Control 2 exceed their respective +2s control limits. It is rare to see two values in a row exceed the same +2s limit, therefore this occurrence indicates a problem with the method. Note that this interpretation applies the 22s control rule, i.e., 2 values in a row exceeding the same control limit. Since both controls are out in the same direction, it is likely there is a systematic error (or problem with the accuracy of the method). Stop, reject the run, trouble-shoot the method, fix the cause of the problem, then restart the method and reanalyze the   patient specimens 
Day 11. Both control values exceed 2s control limits, but one is positive and one is negative. It is a rare occurrence and most likely there is a problem with the method. Since the two controls are out in opposite directions, it is likely that there is a random error (or problem with the precision of the method). Note that this interpretation applies the R4s rule, i.e., the range of the control values exceeds 4s. Stop, reject the run, trouble- shoot the method, fix the cause of the problem, then restart the method and reanalyze the patient specimens.
Day 14. The value for Control 2 is again outside the low end of the 2s range. This makes 2 days or 2 runs in a row, which is unusual. Since both values for Control 2 are out in the same direction, it is likely there is a systematic error (or problem with the accuracy of the method). Stop, reject the run, trouble-shoot the method, fix the cause of the problem, then restart the method and reanalyze the patient specimens.

---------------------------------------------------------------------------------------------------------------------- 

 

Change the font color:

main color:

second color:

انتخاب رنگ پس زمینه:

تغییر اندازه فونت ها:

A-AA+

Change the spacing between words:

Change the distance between the lines:

Change mouse type:

Change the font

Select color blind mode

Red Blindness Green blindness Blue blindness Red difficult Green difficult Blue difficult Monochrome Conical Color
Template settings