Qap (Anatomical Pathology) 

QAP Peer Review

AP94
Case History: Left eye limbal mass encroaching into ciliary body.
Intended diagnosis: Mycobacterial spindle cell pseudotumour. Contributed by:MST
Code Diagnosis Comment Score
anonymous Inflammatory pseudotumour (100%) Advise special stains +/- culture to exclude infective process.  90
anonymous Inflammatory pseudotumour (90% probability) - Infection (5% probability) has to be excluded by performing special stains for microorganisms. - Follicular dendritic cell (FDC)sarcoma (5% probability) has also to be excluded by performing immunostains for FDC markers CD21 and CD35  90
anonymous Inflammatory pseudotumor. 100% Nil  100
anonymous Inflammatory pseudotumor. 100% Need to exclude an infective cause, particularly mycobacterial infection. Special stains such as Ziehl-Neelsen and Grocott stains should be performed.  100
anonymous Left eye limbal mass : INFLAMMATORY PSEUDOTUMOUR. ( 100 % ) Although in most cases a specific aetiology cannot be identified, some cases are associated with Rosai-Dorfman's disease or inflammatory fibrosclerosis. Special stains for organisms may be performed in some cases to exclude an infectious cause.  90
anonymous Kaposi sarcoma 90% Haeangioendothelioma inflammatory pseudotumour PAS stain for eosinophilic globules of Kaposi. CD34 positive in spindle cells. Any history of aids or immunosuppresion would support Kaposi.  10
anonymous Spindle cell lesion Ddx: Inflammatory pseudotumor 50%; FDC tumor 30% Infection 20% Special staining for organism e.g. PASD for fungus, ZN for AFB Immunostaining for FDC markers  100
anonymous Chronic lymphohistiocytic inflammatory lesion. 100%. Suggest special stains +- molecular studies to look for microorganisms, eg. ZN stain for Mycobacteria; Grocott stain for fungi etc.  100
anonymous Inflammatory mass. DDx between inflammatory pseudotumor and other granulomatous infections. 100% Do infective stains e.g. Ziehl Neelsen, Warthin Starry, Grocott, PAS and Gram stains to rule out organisms.  100
anonymous Inflammatory pseudotumour 80% Extranodal SHML 15%% Infection 5% Special stains to rule out organisms Immunostain S-100 protein to rule out SHML  90
anonymous Dendritic cell tumour (80%) Inflammatory pseudotumour if above mentioned studies fail to establish dendritic cell nature (20%) Immunostains CD21, CD23, CD35, S100, CD1a, CD4, CD68, and if possible, EM for confirmation and classification.  30
anonymous Inflammatory pseudotumour with prominent histiocytic reaction 100% suggest exclusion of fungal & atypical mycobacterial infection by special stains & culture. Also further sampling to exclude presence of a benign fibrohistiocytic tumour.  100
anonymous Inflammatory pseudotumor - 100% Suggest : 1. Ziehl-Neelsen and fungal stains to exclude infection 2. S-100 immunohistochemical stain to exclude Rosai-Dorfman disease (S100 positive for Rosai-Dorfman disease.)  100
anonymous Spindle cell lesion with lymphoctes: Follicular dendritic cell sarcoma 90% Inflammatory pseudotumour 5% Other unusual infective process 5% 1. Immunohistochemical staining: CD21, CD35, etc. for FDC sarcoma. 2. Staining for micro-organisms (correlate with microbiological studies) 3. EM studies  50
anonymous Inflammatory pseudotumour 100% Post-thymic T-cell lymphoma is to be excluded by immunohistochemistry and absence of T-cell receptor re-arrangement. Ziehl_Neelsen stain to rule out mycobacterial spindle cell pseudotumour.  100
anonymous Inflammatory pseudotumour. Probability 100%. - Proceed to a panel of special stains for infective organisms: PASD, Grocott, Ziehl-Neelsen, Wade-Fite.  100
anonymous EYE, left eye limbal mass - INFLAMMATORY PSEUDOTUMOR (70%), FOLLICULAR DENDRITIC CELL SARCOMA (10%), MALAKOPLAKIA (10%), MELANOMA (10%) Suggest special stains including gram, PAS, ZN, giemsa to exclude infective causes, Von Kossa and iron stains for malakoplakia, immunohistochemical staining (CD21, CD35) to exclude follicular dendritic cell sarcoma and S-100 to exclude melanoma.  100