—  SPECIALTY CONFERENCE  — Hematopathology Sunday March 21, 7:30 PM Salon 3 and Balconies Lineage Infidelity, Promiscuity and Confusion: What's a Boy/Girl/Hematopathologist To Do? Moderator: ADAM BAGG University of Pennsylvania, Philadelphia, PA Disclosure: In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose. Panelists: ANDREW L. FELDMAN, Mayo Clinic, Rochester, MN DAN JONES, UT-M.D. Anderson Cancer Center, Houston, TX SIBRAND POPPEMA, University of Groningen, Groningen, Netherlands STEVEN H. KROFT, Medical College of Wisconsin, Milwaukee, WI Clinical Histories and Still Images are displayed below. Click on slide thumbnail images for an enlarged view. If you have any difficulties viewing these slides, email or call George Clay at +1.724.449.1137. Case 1 Submitted by: Andrew L. Feldman - Mayo Clinic, Rochester, MN Clinical Summary: A 52 year-old male presented with lymphadenopathy in 2000 and underwent a right inguinal lymph node biopsy (Case 1a). Bone marrow biopsy showed involvement by the same process seen in the lymph node. The patient was treated with immunochemotherapy and had persistent, but stable, disease for the next 8 years. In 2008, at age 61, his lymphadenopathy increased and he underwent a left inguinal lymph node biopsy (Case 1b). Case 1 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1 - Slide 2 Click to view with ImageScope Click to view with a Web-Based Viewer Case 1a - Figure 1 Case 1a - Figure 2 Case 1a - Figure 3 Case 1b - Figure 1 Case 1b - Figure 2 Case 1b - Figure 3 Case 1b - Figure 4 Case 1b - Figure 5 Case 2 Submitted by: Dan Jones - MD Anderson Cancer Center, Houston, TX Clinical Summary: 59 year old man who noted skin lumps for approximately two months followed by enlargement of lymph nodes in the right groin that reportedly regressed somewhat without any therapy. A bone marrow biopsy/aspirate was done, followed by a skin biopsy (slide 1), and a lymph node biopsy (slide 2). The patient responded to therapy but died 4 months following presentation from respiratory failure as a sequelae of treatment. CBC at presentation was Hgb 14.3g/dL, MCV 93 fL, Plt 72 (x 10E9/L), WBC 3.3 (x 10E9/L) with 54% grans, 37% lymphs, 6% monos, and 1% eos. Flow cytometry on disaggregated cells from lymph node showed tumor cells were uniformly positive for CD45, HLA-DR, and CD7 and negative for surface CD3, CD4, CD5, CD8, CD10, CD19, CD20, CD23, and immunoglobulin light chains. Immunostain for CD3 on paraffin section was negative. Cytogenetic analysis performed on short-term cultures of lymph node revealed 45,XY,+8 in 2 of 30 analyzed metaphases. Immunoperoxidase staining of frozen sections of the skin biopsy shows negative staining of most tumor cells for CD2 (T11), CD3 (Leu-4), and CD7 (Leu-9), with weak staining for CD3 and CD7 in some cells. Flow cytometry on disaggregated cells on skin show tumors cells are positive for CD16 and CD56, negative for CD3, CD4, CD5, and B-cell markers. Immunoperoxidase staining done on paraffin sections shows uniform and strong positive staining of neoplastic cells for CD56. Flow cytometry on bone marrow aspirate with gating on the "blasts" show cells are positive for cytoplasmic CD3 and CD56, negative for CD1, CD2, surface CD3, CD5, CD10, CD34, CD64, CD117, TCR-alpha/beta and TCR-gamma/delta. Case 2 - Slide 1 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Slide 2 Click to view with ImageScope Click to view with a Web-Based Viewer Case 2 - Figure 1 Case 2 - Figure 2 Case 2 - Figure 3 Case 2 - Figure 4 Case 2 - Figure 5 Case 2 - Figure 6 Case 2 - Figure 7 Case 3 Submitted by: Sibrand Poppema - University of Groningen, Groningen, Netherlands Clinical History: A 76 year old male, diagnosed with CLL three years earlier Rapidly enlarging lymph nodes Case 3 - Figure 1 H&E, 40x Case 3 - Figure 2 H&E, 40x Case 3 - Figure 3 H&E, 40x Case 4 Submitted by: Steven H. Kroft - Medical College of Wisconsin, Milwaukee, WI Clinical Summary: The patient was a previously healthy Hispanic male with no significant past medical history who presented with a 4-week history of fever, weight loss, and fatigue. Physical examination revealed bilateral posterior cervical, axillary, and inguinal adenopathy, but no hepatosplenomegaly. CBC revealed WBC 390,000/uL, hemoglobin 9.5 g/dL, and platelets 72,000/uL. Case 4 - Figure 1 Case 4 - Figure 2 Case 4 - Figure 3 Case 4 - Figure 4 Case 4 - Figure 5 Case 4 - Figure 6 Case 4 - Figure 7 non-specific (butyrate) esterase Case 4 - Figure 8 Case 4 - Figure 9 Handouts for all Specialty Conferences will be accessible via the "Educational Materials" section on the homepage the morning after each respective conference. Printed copies of the handout will not be available at the meeting.