Qap (Anatomical Pathology) 

QAP Peer Review

AP130
Case History: M/58, Frontal lobe brain lesion.
Intended diagnosis: Malignant lymphoma. Contributed by:JKCC
Code Diagnosis Comment Score
anonymous Malignant lymphoma (80%) High grade glial tumour (20%) Advise immunostains for lymphoid markers (including Ki-1) and GFAP.  100
anonymous High grade malignant tumour consistent with glioblastoma multiforme 100% To exclude lymphoma by immunohistochemistry.  80
anonymous Malignant lymphoma. 100% Confirm by immunohistochemical stain for lymphoid markers.  100
anonymous Glioblastoma multiforme (100%) nil  50
anonymous Diffuse large cell lymphoma Immunostaining for LCA, L26, CD3.  100
anonymous GLIOBLASTOMA MULTIFORME with osteosarcoma-like area. 100% The diagnosis of GBM can be confirmed by GFAP positivity.  50
anonymous Malignant anaplastic neoplasm. (100%) DDx includes malignant lymphoma, especially anaplastic large cell lymphoma; metastatic anaplastic carcinoma; sarcoma including gliosarcoma; and unlikely malignant melanoma and germinoma. Favor malignant lymphoma. Confirm the diagnosis by a panel of immunostains including CD30, EMA and ALK-1 for anaplastic large cell lymphoma; LCA, B- & T-cell markers for other lymphomas; cytokeratins, in addition to other markers to exclude other differentiation, for carcinomas; GFAP and vimentin for glial sarcoma; S-100 protein and HMB-45 for melanoma; PLAP for germinoma.  70
anonymous Brain - large cell lymphoma 100% To apply a panel of immunomarkers to confirm lymphoid nature and to determine lineage.  100
anonymous Malignant lymphoma, - diffuse large cell 80% - anaplastic large cell lymphoma 20% Need to establish lineage by T and B markers. Need to rule out anaplastic large cell lymphoma by CD30(Ki-1), also need to perform ALK-1 for prognostic reason.  100
anonymous High grade malignant neoplasm 100% DDX: Malignant lymphoma, glioblastoma multiforme Suggest immunohistochemical staining with LCA, GFAP for delineation  80
anonymous GLIOBLASTOMA. 100% Suggest to perform immunostain for GFAP to confirm the diagnosis and cytokeratin and leuococyte common antigen to exlude carcinoma and lymphoma.  80
anonymous Malignant neoplasm, favour malignant lymphoma (100%) Glioblastoma multiforme has been considered as a ddx. - Can be distinguished by immunostaining: Lymphoma (LCA+ GFAP-), GBM (LCA- GFAP+)  100
anonymous Giant cell glioblastoma nil  50
anonymous Malignant neoplasm. Favor malignant lymphoma, high grade. Probability : 100% Would perform T & B marker, CD30, ALK, and S100, cytokeratin, GFAP to exclude malignant melanoma, metastatic carcinoma and glioblastoma multiforme.  100
anonymous Large cell lymphoma 90% Glioblastoma multiforme 10% Immunostains including LCA and GFAP to be performed to confirm or disprove the diagnosis of lymphoma or glioblastoma multiforme.  100
anonymous Non-Hodgkin lymphoma (80%) Other differential diagnosis (20%) include glioblastoma multiforme and metastatic undifferentiated carcinoma. Immunohistochemical stain for LCA, B & T-cell markers, cytokeratin and GFAP would be helpful.  100