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2015 Annual Meeting
Evening Specialty Conference - Pediatric Pathology
Sunday, March 22, 2015 - 7:30pm to 9:30pm
CC 309
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Clinical Summary:

16 year old female with a history of multiple light brown macules since age 3 and multiple nodules including a recently growing one in the left popliteal fossa.  MRI reveals an enlarging 6 cm mass which is PET avid.  Surgery resection reveals an "encapsulated appearing mass" as well as a smaller (2.5 cm) distal mass. Subcutaneous nodules were also noted. 










Case title: 12 year-old female with left nasal mass
Clinical Summary:

A 12 year old female presented to a local hospital with a left nasal mass, following a one month history of left sided headache and right sided rhinorrhea. She had no associated swallowing or respiratory issues, no weight loss and otherwise felt fine.  Work-up at the local hospital included CT (see image) and MRI of the head, which was significant for a large heterogenous mass in her left nares extending to the left orbit and sinuses. A biopsy was performed (not shown) showing ulcerated nasal mucosa, underlying granulation tissue, and atypical cartilage, and further work-up was advised. Following a delay of 5 weeks related to lack of insurance coverage, she was seen in our emergency department for nasal bleeding.  MRI studies were repeated (see images), revealing interval increase in size of the enhancing soft tissue mass, primarily centered in and thought to be arising from the medial left maxillary wall and completely occupying and expanding the left maxillary and left nasal cavity.  Another biopsy was obtained (see images).  Based upon the result of this biopsy, a resection was performed (see images).

CT scan
CT scan
MRI
MRI
MRI
MRI
biopsy 2X
biopsy 2X
biopsy 4X
biopsy 4X
biopsy 20X
biopsy 20X
biopsy 20X
biopsy 20X
resection 4X
resection 4X
resection 20X
resection 20X
resection 20X
resection 20X
resection 40X
resection 40X
Clinical Summary:

A healthy 8 year old boy had an abdominal mass discovered during a routine physical exam. Imaging revealed a 6 cm mesenteric mass. There were no laboratory abnormalities or history of fever or weight loss. The mass was resected.

Clinical Summary:

Clinical History:

This 7 year-old health male presented with a painless, nontender swelling of his right upper thigh that was noticed 2 months ago. The mass has recently increased markedly over the past week, as noted by his parents. The mass is now affecting the child's gait and he walks with a limp. The child complains of pain when he runs and he also tires easily. He has normal sensation in his right leg and normal range of motion.  On physical examination, the right thigh is swollen and firm with increased superficial vascularity, but only slightly tender on deep palpation. There is no erythema, warmth, bruits or pulsations. The circumference of the thigh in the lesional area is 20cm.

An initial routine x-ray showed a large medially placed mass that involved the soft tissue, but with the femur showing no involvement. The femur had an intact cortex with no periosteal reaction. CT and MRI surveys demonstrated a large heterogenous, hypervasular mass, with tortuous and enlarged vascular channels. There was arterial drainage into the right iliac artery, with venous drainage into the femoral vein. The mass was considered a high flow lesion, and involved the hamstring compartment and adductor muscles. The lesion measured 18 x 13 x 9cm.

At consensus conference, the radiologic impression was mixed vascular lesion with large AVM component with intralesional hemorrhage.

Prior to embolization of this possible hypervascular lesion with an AVM component, biopsy was performed.

Biopsy H&E
Biopsy H&E
Biopsy H&E
Biopsy H&E