Student:
Jiayin (Jenn) Dong

About the Poster:
Mucocele of the appendix is an uncommon disorder characterized by dilation of the appendiceal lumen due to accumulation of mucinous substance. It has no typical clinical presentation and is considered a potentially premalignant condition, making it challenging yet important to be diagnosed and treated early. If untreated, one type of mucocele may rupture resulting in a potentially fatal condition called pseudomyxoma peritonei. In this case study, a 55-year-old-femal with a large appendiceal mucocele is suspected of malignancy. A right hemicolectomy was performed, and grossing revealed a large cystic lesion protruding into the mesoappendix. Histological evidence provided the diagnosis of low-grade appendiceal mucinous neoplasm (LAMN) with focal extension beyond muscularis propria, ruling out the risk of pseudomyxoma peritonei. Due to the tumor’s location in the ileocecal region, the pathologists’ assistant played a critical role in determining its relationship to all adjacent structures by comprehensive sampling, together with a thorough and meticulous gross examination and description.

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Student:
Brittany Schleeter

About the Poster:
Often referred to as ‘jelly belly syndrome’ and treated with a procedure known as ‘the Sugarbaker,’ Pseudomyxoma peritonei (PMP) is anything but sweet. Pseudomyxoma peritonei is a rare pathological syndrome with an annual occurrence of only 1 2 cases per 1,000,000. PMP most commonly occurs as a result of an appendiceal mucinous neoplasm (AMN) that either extends through the wall of the appendix or causes appendiceal rupture, resulting in dissemination of neoplastic cells within the peritoneal cavity. The most common sites of metastases include the greater omentum, under surface of the right hemidiaphragm, right subhepatic space, and paracolic gutter. These mucin producing metastases result in the formation of mucinous ascites, a clinical finding pathognomonic of pseudomyxoma peritonei and how PMP came to be known as ‘jelly belly syndrome.’ Currently, the only treatment for pseudomyxoma peritonei is cytoreductive surgery (CRS) followed by hyperthermic intraperitoneal chemotherapy (HIPEC), a procedure colloquially referred to as ‘the Sugarbaker.’ Despite the aggressiveness of this approach, the 5 year overall survival rate is just over 50%.

Although uncommon to receive an AMN with a clinical history of PMP, it is essential for pathologists’ assistants (PAs) to be comfortable accessioning and grossing these specimens. Familiarity with both the gross and histological features of pseudomyxoma peritonei ensures that PAs will save the appropriate tissue for cytological, molecular, and genetic testing as well as submit pertinent sections for microscopic review; however, PMP can be intimidating. Literature regarding pseudomyxoma peritonei is often contradictory and the classification of PMP only recently became standardized. The goal of this poster is to present a clear, concise overview of pseudomyxoma peritonei in order to improve pathologists’ assistants’ understanding of this rare pathological syndrome.

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Student:
Monet Kumazawa

About the Poster:
Alzheimer’s disease is the most common type of dementia, presenting as mild memory loss and resulting in progressive loss of ability to carry out daily activities. Gross pathology shows enlarged ventricles and a shrunken hippocampus. Microscopic examination reveals an accumulation of insoluble fibrous material with extracellular amyloid and neurofibrillary tangles (NFT). Societally, Alzheimer’s disease is a puzzling degenerative neurologic disorder that we still have no clinical treatment for or an official metric for pre-clinical diagnosis.

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Student:
Megan Kwan

Contributor:
Mande Beers, MHS, PA(ASCP), Ivan Gonzales, MD and Jennifer Pogoriler, MD, PhD – Children’s Hospital of Philadelphia

About the Poster:
Osteosarcoma is an aggressive malignant bone forming tumor. It is the most common primary malignant tumor of the bone and the third most common cancer of adolescence. The most common locations are the metaphysis of long tubular bones, such as the proximal humerus, the distal femur, and the proximal tibia. Patients typically present with localized pain and swelling. MRI is a useful tool for local staging, particularly for evaluation of intraosseous tumor extension and soft tissue involvement. Though most cases of osteosarcoma are sporadic, Rothmund-Thomson Syndrome (RTS) is an autosomal recessive disorder, often seen with pathogenic variants in RECQL4, that is associated with an increased risk of osteosarcoma development. Poikiloderma, small stature, sparse or absent scalp hair, skeletal dysplasia, and/or juvenile cataracts can also be seen in this disorder. Patients with RTS and other genetic predisposition syndromes usually present at a younger age and the tumor may involve multiple sites.3 Synchronous Multicentric Osteosarcoma (SMOS) is a rare variant of osteosarcoma characterized by tumors in multiple osseous sites at diagnosis in the absence of pulmonary metastasis. To make an accurate diagnosis of SMOS, primary osteosarcoma with bone seeking metastasis and direct extension from the primary tumor must be ruled out. Both solitary primary osteosarcoma and SMOS are typically treated with neoadjuvant chemotherapy and surgical excision, however patients with SMOS have a much worse prognosis.

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Student:
Emily Amato

Contributor:
Shaymaa Ashi, MD, St. Luke’s University Hospital, Bethlehem, Pa.

About the Poster:
Primary fallopian tube carcinoma is rare and often already invasive at the time of diagnosis. The following case is that of a woman who presented with postmenopausal bleeding, believed to be attributed to a very large and likely benign endometrial polyp. Since the protocol for grossing a TLH-BSO specimen involves heavy sampling of the fallopian tubes and ovaries, the pathologist was able to discover multifocal invasive and metastasizing serous carcinoma, originating from the fallopian tube.

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Student:
Sarah Lock

Contributor:
Khalil Wardak, MD

About the Poster:
Lipomatous hypertrophy of the interatrial septum (LHIS) is a benign condition characterized by the accumulation of adipose tissue in the interatrial septum, which spares the fossa ovalis. While LHIS is not a true tumor, it should be considered in the differential diagnosis when an adipose cardiac tumor, such as a cardiac lipoma, is discovered. Most cardiac tumors are benign, and many are incidentally diagnosed upon autopsy. However, due to the location and size, benign cardiac tumors may impede blood flow and cause arrhythmias, leading to death. We report the case of a woman who died due to complications of previously-undiscovered LHIS.

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Student:
Lauren E. Nerotto, Pathologists’ Assistant Student, Drexel University College of Medicine, Philadelphia, PA

Contributor:
Judy Pascasio, MD , St. Christopher’s Hospital for Children, Philadelphia, PA

About the Poster:
Infection, sepsis, tissue necrosis and decreased blood volume are just some of the life-threatening factors to consider when treating severely burned patients. Electrical burns are much more common in young men but overall are a relatively rare pathology. For many patients, amputations are a measure used to remove gangrenous and infected tissue thereby increasing the patients’ chance of survival.

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Student:
Taylor Marvin

Contributor:
Angela Pietsch, PA(ASCP), Paoli Hospital, Paoli, Pa.

About the Poster:
Renal cell carcinoma (RCC), clear cell type with rhabdoid differentiation is an uncommon, aggressive tumor most commonly found in adult men over the age of 40. The rhabdoid component of the tumor is thought to be due to dedifferentiation of the parent cells and can present in other types of renal cell carcinomas, though it is most often associated with clear cell type. These tumors usually present with minimal symptoms and metastasize quickly, making it difficult to identify and treat the tumor. The late presentation, low incidence of this tumor, and aggressive nature have made it a challenge to establish a standard treatment for this tumor type, and studies have shown minimal success in reduction of mortality with various treatment options.

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Student:
Mary Erdman

Mentors:
Abington Hospital-Jefferson Health
Kathleen Brown, PA (ASCP)CM
Karen Bell, MD

About the Poster:
A 49-year-old male presented with the chief complaint of increasing leg swelling for the past 3 weeks. In the past 6 weeks, he had also experienced increasing abdominal girth with distention, discomfort, and constipation. He reported dyspnea on exertion, intermittent lightheadedness, fatigue, and anorexia. He believed he gained about 50 pounds in the past 6 weeks. The patient is morbidly obese with a short medical history of diverticulosis and asthma. He has been a 1 pack/day smoker for the past 20 years. His mother, also a smoker, died of lung cancer. Imaging studies, including abdominal MRI and abdominal CT with contrast, showed a mass almost completely filling the right atrium and obstructing the tricuspid valve. The architecture of the liver was heterogeneous, suggesting hepatitis. There were also 2 masses in the liver and multiple small nodules in the lungs. The patient had bilateral pleural effusions, a pericardial effusion, ascites, and diffuse subcutaneous tissue edema. He underwent resection of the atrial mass to alleviate his volume-overload symptoms.

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Student:
Lindsey Wilson

Mentors:
Kelly Menges, PA(ASCP)-Abington Memorial Hospital

About the Poster:
Although gastroschisis is a frequently studied abdominal wall defect, it continues to be researched as many believe the condition has an environmental component. Unlike omphalocele, a similar abdominal wall defect, the organs are not covered by a protective sac. Thus, the severity of gastroschisis depends on the number of protruding organs as well as the duration they are exposed for. In this particular case, a woman from Brazil presented to a hospital in Pennsylvania for a follow-up on the condition of her fetus. Through techniques such as gross and microscopic dissection, as well as microarray testing, her fetus was discovered to have gastroschisis and trisomy 18. Read more.

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Student:
Kelly Hollar

Mentors:
Kelly Menges, PA(ASCP)-Abington Memorial Hospital

About the Poster:
Testicular germ cell tumors (GCTs) cause approximately 10% of all cancer deaths in men 15- 34 years old and are a histologically diverse category of neoplasms that consist of a mixed cell type in 40- 45% of cases. Choriocarcinoma is the rarest and most highly malignant subtype of GCT and can present with diffuse metastasis at the time of diagnosis. It is found as the only cellular subtype in less than 1% of all GCTs and is found as a component in only eight- 10% of mixed GCTs. Here, a case of mixed GCT comprised of >95% choriocarcinoma, presents as a painless testicular growth with lung and lymphatic metastasis. The patient’s prognosis and treatment are dependent not only tumor invasion but on proper identification of each histologic subtype. The pathologist assistants’ care in selecting sections is vital.

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Student:
Britni Stowell

Mentors:
James W. Moore, PA(ASCP)CM
Dr. Edina Grujic, MD - Bryn Mawr Hospital

About the Poster:
The patient is an 81 year old male who first presented in May 2019 with a sizeable mass on the left anterior thigh, which is grossly visible. The patient states that the mass is not painful and has been growing for the last two years. He has decided to seek medical attention due to his recent significant weight loss and fatigue. Upon palpation the mass is nontender. There is no weakness of the leg, no tingling or neurological defects, and no regional lymphdenopathy. In addition the patient has an extensive medical history including GERD, hypertension, multiple heart surgeries, BPH, hernias, and multiple melanoma excisions from the scalp and left hand in 2015. The patient has no family history of other malignancies or soft tissue masses.

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Student:
Kelly Baxter, HT (ASCP)CM, PA (ASCP)*

Mentors:
David Beckles, PA (ASCP)CM
Annabel Canhao, PA (ASCP)CM

About the Poster:
Colorectal cancer is the most common gastrointestinal malignancy and contributes to nearly 10% of all cancer deaths, second only to lung cancer. North America has the highest incidence and disease peaks between 60 to 70 years of age. Colonic adenocarcinomas are distributed along the length of the colon, growing as exophytic masses in the proximal colon and annular, constricting lesions in the distal colon. Colon adenocarcinoma most commonly metastasizes to the liver as a result of portal drainage, but may also metastasize to regional lymph nodes, lungs and bones.

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Student:
Steven M. Vanko MS, PA

Mentors:
Sarra-Valentina Klimberg, MS, PA (ASCP)cm
Katrina A. Conard, MD

About the Poster:
Familial adenomatous polyposis is (FAP) is a rare and largely inherited cancer predisposition syndrome⁵. FAP occurs in around 1 in 10,000 people¹. With this condition, individuals will develop numerous, precancerous adenomatous polyps throughout their colon and rectum¹. The polyps start to develop in the teen years to early 20’s (mean age of 16), and by 35 years old, 95% of patients will have polyps⁵. With age these polyps will increase in number and in size, and eventually one of these polyps will become cancerous. In fact, colon cancer is inevitable without colectomy, and adenocarcinoma develops at a mean age of 39 in untreated patients².

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Student:
Brian Chase

Mentors:
David Kirschenmann, PA (ASCP)
Pradeep K. Bhagat, MD, Lankenau Medical Center

About the Poster:
The patient is a 46-year-old female who presented with a large, exophytic cervical lesion upon physical examination by her physician. A PET-CT scan was performed to confirm the presence of the cervical lesion and positive pelvic lymph nodes. The patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and lymph node dissection to be followed by chemotherapy and radiation.

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Student:
Mark Vincent C. Olorvida, MHS

Faculty:
Christos D. Katsetos, MD, PhD, FRCPath, Ahmed Abdulrahman, MD, Drexel University College of Medicine, Philadelphia, Pa.

About the Poster:
A 66-year-old Caucasian woman presented with a history of depression, anxiety, and dementia for about 2 years. She demonstrated multiple cognitive difficulties including memory deficit, and she later became more confused, agitated, and at times, delusional. She was employed at a bank, but lost her ability to do simple mathematics. For the last year of her life, her skills with a variety of motor functions declined. Her walk became unsteady and she started to have frequent falls and gait dysfunction. She frequently experienced right-sided headaches and her behavior progressively changed with psychotic symptoms.

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Student:
Kevin O'Connor

Faculty:
Jeanine Chiaffarano, DO, University of Medicine and Dentistry of New Jersey
Marta Guttenburg, MD, The Children's Hospital of Philadelphia

About the Poster:
This is the case of a 13-day-old female infant delivered at 34 2/7 weeks to a 38-year-old G1P0 mother with spontaneous rupture of membranes, via cesarean section on 2/26. Prenatally, the infant was diagnosed with an omphalocele and a 17q12 duplication encompassing the HNF1B gene; the karyotype was normal female.

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Students:
Molly C. Pitluck, BS, PA (ASCP)
Steve Sowers, BS, PA (ASCP)

Faculty:
Sharon L. Swierczynski, MD, PhD, The Reading Hospital and Medical Center, Reading, Pa.

About the Poster:
In January 2013, a 64-year-old white male presented with chief complaints of right tibia and ankle pain as well as open wounds in his right lower leg for the last couple of months. The patient's past medical history was significant for poorly differentiated infiltrating adenocarcinoma of the rectosigmoid colon (PT3C/D), status post partial colectomy in 2007; metastatic adenocarcinoma to the right distal tibia, consistent with a colon primary (CEA, CK20, CDX2 positive; CK7, TTF-1 negative), in 2009, status post prophylactic rodding in 2011; and metastatic adenocarcinoma to right groin lymph nodes consistent with a colon primary, status post excision in 2010. Additional PMH included hypertension, hypercholesterolemia, status post appendectomy in 1961, history of detached retina in 1990, and status post left ankle fracture in 1998.

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Student:
Molly Lundy

Faculty:
Dr. Adamec and Dr. Kimmel, The Reading Hospital and Medical Center, Reading, Pa.

About the Poster:
Extramammary Paget Disease (EMPD) is a malignant and destructive skin lesion often seen in concurrence with an underlying malignancy (such as in the more common mammary type), but can also arise de novo4,6. These primary lesions are commonly found in areas rich in apocrine sweat glands such as the vulva, perianal region, axilla, mons pubis, glans penis and eyelid4 (listed in order of occurrence). There are multiple hypotheses for this presentation. Two common understandings are that it appears as an epidermotrophic metastasis from a visceral carcinoma, commonly uterine or rectal, or within the skin arising from apocrine derivation. It is important to determine the derivation of an extramammary case in order to rule out an undiagnosed underlying visceral carcinoma.

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Student:
Anthony Pinto, MS, PA (ASCP)

Faculty:
Suresh Majmundar, PA (ASCP)
Corrado Minimo, MD, Albert Einstein Medical Center

About the Poster:
Breast cancer is much less common in men than in women. Male patients are older and show more advanced disease at the time of clinical presentation. Furthermore, invasive ductal carcinoma predominates in men >90% of the time, while ductal carcinoma in-situ (DCIS) and lobular carcinomas are less common or rare in comparison with women.

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Student:
Alice Sedlak

About the Poster:
Paraganglia are neural crest derived cells, and as such, they are found along the embryologic migration routes of neural crest tissue from the base of the skull to the lower pelvis, not including the area of the extremities. 1,2 They are most closely associated with blood vessels, where they act as chemoreceptors, such as in the carotid body.1 Paragangliomas are neoplasms that arise from these paraganglia, usually as a benign tumor. These extra adrenal paragangliomas are histochemically non-chromaffin, and tend to be located in the head and neck region, superior mediastium, and retroperitoneum.3 Specifically, the most common locations are the carotid body, jugular bulb, Jacobson's tympanic plexus in the middle ear, and the vagal nerve.2 Overall, paraganglioma of the head and neck region are incredibly rare and constitute only 0.012% of tumors in that area, and due to their strong association with blood vessels, an overwhelming 80% of these paragangliomas arise from the carotid body.

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Student:
Brian Hoffman, MS, PA (ASCP)

Faculty:
Joseph A. DiRienzi, PA (ASCP)
Igor Tsimberg, PA (ASCP)
Grant Nybakken, MD, PhD
Charuhas Deshpande, MD

About the Poster:
Adenocarcinoma of the prostate is the most common form of cancer in men, typically affecting men over the age of 50. The etiology of prostatic adenocarcinoma is unclear, although there are several factors suspected in contributing to the disease such as: age, race, hormone levels and environmental influences. The tumor can be incidentally discovered with little clinical significance or it can be an aggressive and lethal cancer. Prostate cancer is graded with the Gleason system, which divides prostate cancers into five grades. The higher the grade, the poorer the prognosis for the patient. Metastasis more than likely occurs with advanced prostate cancer and has a tendency to spread to the bone via hematogenous spread.

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Student:
Jacob Mirbegian, 2nd Year PathA, Drexel University Sacramento

Contributors
Kristin Motz, PA (ASCP), Mary Tomic, MD

About the Poster:
Neuroblastoma is the most common solid extra-cranial tumor of infancy and also the most frequently diagnosed tumor of infancy.¹ The median age of diagnosis is 18 months with approximately 40% of cases being diagnosed in infancy. Because of this, it is considered one of the most important neoplasms that may arise from the sympathetic ganglia or in close proximity to the kidneys and adrenals. A right upper quadrant mass was incidentally noted on a 17-year old male while undergoing imaging for unrelated reasons. The mass was revealed to be a neuroblastoma, despite the patient having normal urine cortisol and metanephrine levels, and a right adrenalectomy was performed. However, bone marrow biopsy later showed metastasis and the patient was subsequently started on chemotherapy.

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Student:
Alina Dausey, MS, PA (ASCP)

Faculty:
Joseph Horstmann, MD and Kimberly Heightchew, MD, Paoli Hospital, Paoli, Pa.

About the Poster:
Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung, and colon. Basal cell carcinoma is the most common form of skin cancer and squamous cell carcinoma is the second most common form. Melanoma accounts for only 5% of all skin cancers, but it is the most deadly, accounting for 75% of all skin cancer deaths.