Qap (Anatomical Pathology) 

QAP Peer Review

AP302
Case History: F/76 Right breast mass
Intended diagnosis: Granulocytic sarcoma. Contributed by:JKCC
Code Diagnosis Comment Score
anonymous Low grade lymphoma infiltrate CD3, L26, MPO immunostains  70
anonymous lymphoma perform immunostaining of hematolymphoid marker such as LCA,L26,CD3,etc to assess diagnosis.  50
anonymous Lymphoma perform hematolymphoid marker immunostaining of LCA, L26,CD3 etc...to assess diagnosis.  50
anonymous Haematolymphoid malignancy, 100% Favour medium sized lymphoma Immunostaining with CD3, CD20, MPO, Tdt Immunostain for MNF116 to rule out carcinoma.  100
anonymous Hematolymphoid malignancy (with "blastoid" appearance) Immunohistochemical studies to demonstrate lineage of the tumor cells e.g. blastoid mantle cell lymphoma, blastic plasmacytoid lymphoma, granulocytic sarcoma. Panel may include CD3, CD20, bcl-1, Myeloperoxidase, CD56, etc.  100
anonymous HEMATOLYMPHOID MALIGNANCY. Favor small cell lymphoma eg. maltoma. Other ddx: mantle cell lymphoma, B-CLL. Other ddx, granulocytic sarcoma, T-cell lymphoma including gamma delta type. Remote ddx: invasive lobular carcinoma. Do B and T markers, CD5/10/23, myeloperoxidase, CK. Also to exclude primary elsewhere.  100
anonymous Myeloid sarcoma (granulocytic sarcoma) (100%) nil  100
anonymous Breast - hematolymphoid neoplasm, favor granulocytic sarcom 100% Special stain chloroacetate esterase for supporting diagnosis. Also to correlate with blood and marrow findings.  100
anonymous Malignant infiltrate 100% Differential diagnosis includes invasive lobular carcinoma and malignant lymphoma. Immunostains for cytokeratin and LCA are useful to differentiate the two. The resection margin is involved.  50
anonymous Malignant tumour. DDx are haematolymphoid malignancy and lobular carcinoma Immunohistochemical stains to differentiate the type of malignancy  50
anonymous Involved by Chronic lymphocytic leukemia / Small lymphocytic lymphoma. nil  30
anonymous HAEMATOLYMPHOID NEOPLASM, favour medium sized lymphoma. Differential diagnosis includes myeloid sarcoma and low grade B cell lymphoma. nil  100
anonymous Hematolymphoid malignancy (100%) nil  30
anonymous Favor Haematolymphoid malignancy (including granulocytic/myeloid sarcoma) over small cell invasive lobular carcinoma 100% In real life, one will always perform immunohistochemical study, starting with epithelial (cytokeratin) and lymphoid (LCA, CD3, CD20) markers, followed by E-cad and p120-catenin if cytokeratin positive and possible MPO (for positive diagnosis of granulocytic/myeloid sarcoma).  100
anonymous hematolymphoid malignancy, favor granulocytic sarcoma (100%) Perform immunostaining to confirm the diagnosis and to rule out lymphoma and carcinoma: MPO, Tdt, CD3, CD20, cytokeratin  100
anonymous Breast: atypical lymphoid infiltration favors malignant lymphoma of small lymphoid cells, including small lymphocytic lymphoma (positive for CD23 and CD5), mantle cell lymphoma ( positive for cyclin D1), extranodal marginal cell lymphoma (negative for CD5, CD23, cyclin D1) and leukemic infiltration should also be ruled out (positive MPO) by performing relevant immunohistochemical stains. (100% probability) nil  100
anonymous Lymphoid lesion. ? maltoma nil  30
anonymous Malignant lymphoid infiltrate, consistent with low-grade lymphoma (90%) Invasive lobular carcinoma (10%) Confirm by performing CD3, CD20, MNF116 and E-Cadherin immunostains  50
anonymous Granulocytic sarcoma (70%), lymphoblastic lymphoma (30%) Do immunohistochemistry myeloperoxidase to confirm granulocytic sarcoma; and TdT to confirm lymphoblastic lymphoma  100