AndrewFolpe
@folpe-mn-st.bsky.social
I like my wife and family, bikes, music, dogs, baking bread and soft tissue tumors. Only the last here though.
Well, it turned out he had a tumor in the same laryngeal location a few years ago, diagnosed as a “fibroinflammatory lesion with some features of IgG4 disease”.
June 12, 2025 at 9:06 PM
Well, it turned out he had a tumor in the same laryngeal location a few years ago, diagnosed as a “fibroinflammatory lesion with some features of IgG4 disease”.
It’s also got some bland spindle cell areas.
June 12, 2025 at 9:02 PM
It’s also got some bland spindle cell areas.
Just because the ddx includes intravascular lymphoma (at one time known as “intravascular angioendothelioma”), the first pic is CD20. The others of course are CD31 and CD34.
June 5, 2025 at 7:17 PM
Just because the ddx includes intravascular lymphoma (at one time known as “intravascular angioendothelioma”), the first pic is CD20. The others of course are CD31 and CD34.
There is a single case report of a desmoid occurring in a Li-Fraumeni patient, with identical morphology. p53 IHC done on this case shows a null/mutated pattern.
May 30, 2025 at 5:36 PM
There is a single case report of a desmoid occurring in a Li-Fraumeni patient, with identical morphology. p53 IHC done on this case shows a null/mutated pattern.
Fear not. It’s also got these really bizarre cells, all over the place. Those don’t belong in a desmoid! Not a desmoid? Or is there another explanation?
May 30, 2025 at 5:33 PM
Fear not. It’s also got these really bizarre cells, all over the place. Those don’t belong in a desmoid! Not a desmoid? Or is there another explanation?
#PathSky Abdominal wall mass, middle aged woman. Women basically only get 3 abdominal wall tumors, so it’s got to be a desmoid, DFSP or endometriosis. Classic desmoid morphology, aberrant nuclear beta-catenin. I can hear the cries of “boring..”
May 30, 2025 at 5:31 PM
#PathSky Abdominal wall mass, middle aged woman. Women basically only get 3 abdominal wall tumors, so it’s got to be a desmoid, DFSP or endometriosis. Classic desmoid morphology, aberrant nuclear beta-catenin. I can hear the cries of “boring..”
Pics would be nice, right?
May 20, 2025 at 9:33 PM
Pics would be nice, right?
#PathSky Middle aged woman, leg mass. It all looks like this. More nuclear palisading/ Verocay bodies than you’ve seen in your entire career. Nerve sheath? S100/Sox10 negative. LMS? Negative for all the muscle markers. Any other ideas?
May 20, 2025 at 9:30 PM
#PathSky Middle aged woman, leg mass. It all looks like this. More nuclear palisading/ Verocay bodies than you’ve seen in your entire career. Nerve sheath? S100/Sox10 negative. LMS? Negative for all the muscle markers. Any other ideas?
Oops, I forgot the MDM2 photo.
May 14, 2025 at 3:29 PM
Oops, I forgot the MDM2 photo.
So we’re done, right? “Spindle cell melanoma- next case”. Oddly, SOX10, however was absent in about 50% of cells, as seen in MPNST. H3K27me3 expression was retained, which doesn’t help. PRAME was negative.
May 8, 2025 at 4:48 PM
So we’re done, right? “Spindle cell melanoma- next case”. Oddly, SOX10, however was absent in about 50% of cells, as seen in MPNST. H3K27me3 expression was retained, which doesn’t help. PRAME was negative.
In the skin, this morphology almost always points towards spindle cell melanoma. Now, if you looked around, there were small areas resembling a pre-existing neurofibroma, but this is an “entry level” pitfall in the diagnosis of spindle cell melanoma. S100 protein is also diffusely positive.
May 8, 2025 at 4:41 PM
In the skin, this morphology almost always points towards spindle cell melanoma. Now, if you looked around, there were small areas resembling a pre-existing neurofibroma, but this is an “entry level” pitfall in the diagnosis of spindle cell melanoma. S100 protein is also diffusely positive.
#PathSky 45 with a forearm skin tumor. Highly cellular, monomorphic spindle cell tumor with a “packeted” pattern and deep, nodular lymphoid aggregates.
May 8, 2025 at 4:36 PM
#PathSky 45 with a forearm skin tumor. Highly cellular, monomorphic spindle cell tumor with a “packeted” pattern and deep, nodular lymphoid aggregates.
Those of you following my cases know the answer is usually “look at the slides some more”.
May 2, 2025 at 6:24 PM
Those of you following my cases know the answer is usually “look at the slides some more”.
#PathSky Large, left sided abdominal/retroperitoneal mass in an older adult. Spindle cell proliferation with associated inflammation. All the outside IHC were negative. What to do next? MDM2 FISH? NGS? Methylation?
May 2, 2025 at 6:22 PM
#PathSky Large, left sided abdominal/retroperitoneal mass in an older adult. Spindle cell proliferation with associated inflammation. All the outside IHC were negative. What to do next? MDM2 FISH? NGS? Methylation?
And then there are these mucous nodules, with very nice pseudolipoblasts. Diagnosis?
April 29, 2025 at 6:41 PM
And then there are these mucous nodules, with very nice pseudolipoblasts. Diagnosis?
There are some odd looking cells around the hyaline fibrosis, though. Some with really big nucleoli.
April 29, 2025 at 6:40 PM
There are some odd looking cells around the hyaline fibrosis, though. Some with really big nucleoli.
#PathSky 43M, forearm mass. At first glance, it looks like some kind of inflammatory process, maybe a synovitis with plasma cells, fibrosis and foamy macrophages.
April 29, 2025 at 6:38 PM
#PathSky 43M, forearm mass. At first glance, it looks like some kind of inflammatory process, maybe a synovitis with plasma cells, fibrosis and foamy macrophages.
At high power, the cells in this mass are rather bland, epithelioid, and somewhat myoid. HMB45, Melan A and cathepsin K are positive. Lipomatous angiomyolipoma. These can be sneaky….
April 23, 2025 at 7:46 PM
At high power, the cells in this mass are rather bland, epithelioid, and somewhat myoid. HMB45, Melan A and cathepsin K are positive. Lipomatous angiomyolipoma. These can be sneaky….
#PathSky 55F, large retroperitoneal mass. Outside pathologist quite reasonably thought of WDL, but MDM2 FISH was negative. Any other ideas?
April 23, 2025 at 7:43 PM
#PathSky 55F, large retroperitoneal mass. Outside pathologist quite reasonably thought of WDL, but MDM2 FISH was negative. Any other ideas?
Any immunos you might want? How about CD61, hemoglobin and CD43? Any hx you might want?
April 15, 2025 at 6:05 PM
Any immunos you might want? How about CD61, hemoglobin and CD43? Any hx you might want?
