Qap (Anatomical Pathology) 

QAP Peer Review

AP199
Case History: F/40 Right breast mass
Intended diagnosis: Granulocytic sarcoma of breast. Contributed by:USK
Code Diagnosis Comment Score
anonymous Malignant tumour (100%), suggestive of granulocytic sarcoma. Differential diagnoses -malignant lymphoma, lobular carcinoma Immunostains for myeloperoxidase and c-kit for confirmation of granulocytic sarcoma; LCA, L26 and CD3 to exclude lymphoma and CK to exclude carcinoma  100
anonymous Highly suspicious of carcinoma nil  50
anonymous Granulocytic sarcoma 100% Confirmation with immunostains: Positive with myeloperoxidase, negative for LCA (lymphomas) and cytokeratin (excluding lobular carcinoma).  100
anonymous Hematolymphoid malignancy, favor myeloid leukemia 80% Infiltrative lobular carcinoma 20% Confirm diagnosis by immunostains: MPO for myeloid leukemia, CD20/CD3 for lymphoma, cytokeratin for lobular carcinoma  100
anonymous GRANULOCYTIC SARCOMA 100% To be confirmed by myeloperoxidase stain. The differential diagnosis of large cell lymphoma can be excluded by negativity for lymphoma markers. Remote possibility of invasive lobular carcinoma also can be excluded by negative cytokeratin stain.  100
anonymous Malignant infiltration. DDx between hematolymphoid malignancy and infiltrative carcinoma mainly of lobular type. (100%) Do immunostains including myeloperoxidase, CD34 and c-kit (for leukemia); LCA (for lymphoma); and keratin (for carcinoma).  100
anonymous Right breast mass - Granulocytic sarcoma 100% To correlate with blood and bone marrow findings - any AML?  100
anonymous Malignant, consistent with invasive lobular carcinoma (100%) with focal lobular carcinoma in-situ (LCIS) present , to be confirmed by immunostains for epithelial cell marker (CK) and E-cadherin nil  50
anonymous Infiltrative lobular carcinoma 100% nil  50
anonymous General architecture compatible with Infiltrating malignant tumor. Differential diagnosis include Infiltrating lobular carcinoma and Malignant lymphoma. Perform Pancytokeratin and LCA for confirmation.  70
anonymous Invasive lobular carcinoma 100% nil  50
anonymous Haematolymphoid malignancy, probably lymphoma 100% Immunostains: lymphoid CD45, CD20, CD3, CD30 MPO to exclude granulocytic sarcoma  100
anonymous Malignant infiltrate, favor hematolymphoid malignancy, differential diagnoses include pleomorphic lobular carcinoma and angiosarcoma Need immunohistochemistry for definitive diagnosis  70
anonymous Sclerosing lymphocytic lobulitis (diabetic mastopathy) nil  0
anonymous Leukaemic infiltrate, confirmed by CAE and MPO, would exclude lymphoma and lobular carcinoma by immunostaining. 100% Probability nil  100
anonymous Malignant infiltration, favour leukaemic infiltrates (90%), invasive carcinoma (10%) Correlate with clinical history; enzyme stain for CAE ( positive in leukaemic infiltrates) and immunostain for cytokeratin (positive in carcinoma).  100
anonymous Haematolymphoid malignancy. Probably Granulocytic sarcoma. Confirm by myeloperoxidase immunostain. To exclude lymphoma with panel of T and B-cell markers.  100