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1 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 1 of 110
2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 2 of 110
3 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 3 of 110
4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 4 of 110
5 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 5 of 110
6 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 6 of 110
7 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 7 of 110
8 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 8 of 110
9 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 9 of 110
10 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 10 of 110
11 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 11 of 110
12 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 12 of 110
13 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 13 of 110
14 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 14 of 110
15 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 15 of 110
16 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 16 of 110
17 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 17 of 110
18 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 18 of 110
19 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 19 of 110
20 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 20 of 110
21 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 21 of 110
22 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 22 of 110
23 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 23 of 110
24 Case 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 24 of 110
25 Case 2 44 y/o male presents for CT of the abdomen and pelvis. History of ½ pack/day tobacco use (current) for a total of at least 15 pack years. Anxiety disorder. History is otherwise withheld. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 25 of 110
26 Case 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 26 of 110
27 Case 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 27 of 110
28 Case 2 Ddx: Multiple hypoattenuating liver lesions: Congenital / vascular Simple hepatic cysts Hepatic cavernous hemangiomata Autoimmune / collagen-vascular disease Sarcoidosis Neoplasia Hepatic adenomata Lymphoma Metastatic disease to the liver Hepatocellular carcinoma Infection Hyatid cysts (characteristic with internal sepatations / daughter cysts ) ascending cholangitis pyogenic abcesses amebic abcesses Fibropolycyctic disease Caroli disease autosomal dominant polycystic liver disease Multiple biliary hamaratomata Presentation material is for education purposes only. All rights reserved URMC Radiology Page 28 of 110
29 Case 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 29 of 110
30 Case 2 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 30 of 110
31 Liver, ultrasound-guided FNA: Diff-Quik stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 31 of 110
32 Liver, ultrasound-guided FNA: Diff-Quik stain, 40x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 32 of 110
33 Liver, ultrasound-guided FNA: Papanicolaou stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 33 of 110
34 Liver, ultrasound-guided FNA: Papanicolaou stain, 40x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 34 of 110
35 Liver, cell block: Hematoxylin and eosin stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 35 of 110
36 Liver, ultrasound-guided fine needle aspiration: Malignant tumor cells present derived from adenocarcinoma consistent with colorectal primary. Cell block and cytologic preparations examined. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 36 of 110
37 Liver, right, core needle biopsy: Moderately to poorly-differentiated adenocarcinoma consistent with colorectal primary. Comment: The tissue block will be sent for Kras testing. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 37 of 110
38 Liver, right, core needle biopsy: H & E stain, 10x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 38 of 110
39 Liver, right, core needle biopsy: H & E stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 39 of 110
40 Rectum, biopsy: (outside slide consultation) Adenocarcinoma, moderately to poorly-differentiated. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 40 of 110
41 Rectum, biopsy: H & E stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 41 of 110
42 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 42 of 110
43 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 43 of 110
44 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 44 of 110
45 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 45 of 110
46 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 46 of 110
47 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 47 of 110
48 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 48 of 110
49 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 49 of 110
50 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 50 of 110
51 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 51 of 110
52 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 52 of 110
53 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 53 of 110
54 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 54 of 110
55 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 55 of 110
56 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 56 of 110
57 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 57 of 110
58 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 58 of 110
59 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 59 of 110
60 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 60 of 110
61 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 61 of 110
62 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 62 of 110
63 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 63 of 110
64 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 64 of 110
65 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 65 of 110
66 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 66 of 110
67 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 67 of 110
68 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 68 of 110
69 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 69 of 110
70 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 70 of 110
71 Case 4 56 y/o woman referred from outside institution with back pain and new lytic lesion in thoracic spine. Remote history of urothelial bladder cancer. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 71 of 110
72 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 72 of 110
73 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 73 of 110
74 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 74 of 110
75 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 75 of 110
76 Case 4 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 76 of 110
77 Case 4 Single or multiple lesions? Axial or appendicular? Lytic or sclerotic margins? Periosteal reaction? Age of patient? Pediatric vs adult patient, status of physes Presentation material is for education purposes only. All rights reserved URMC Radiology Page 77 of 110
78 Case 4 Ddx single mixed lytic/sclerotic bone lesion: Osteomyelitis Tuberculosis Ewing sarcoma Metastatic disease to bone Osteosarcoma Presentation material is for education purposes only. All rights reserved URMC Radiology Page 78 of 110
79 Case 4 Metastatic disease to bone: metastatic disease outnumbers primary bone neoplasms 25:1 50% of people with cancer will eventually develop metastatic disease to bone 80% of all metastatic bone lesions are due to lung, breast, pancreas, kidney predilection for red marrow spaces, therefore skull, spine, ribs, pelvis, humeri, femora Presentation material is for education purposes only. All rights reserved URMC Radiology Page 79 of 110
80 Case 4 Ddx adrenal mass: adrenal adenoma (absolute HUs vs. contrast and washout value) metastases lymphoma (primary or metastatic) pheochromocytoma (larger, may have calcifications or necrosis; often component of syndromes including MEN II and III, NF, vhl, Carney syndrome, tuberous sclerosis) adrenal carcinoma (larger, claw sign ) adrenal hyperplasia Presentation material is for education purposes only. All rights reserved URMC Radiology Page 80 of 110
81 Bone, vertebrae, T12, CT-guided FNA: Diff-Quik stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 81 of 110
82 Bone, vertebrae, T12, CT-guided FNA: Diff-Quik stain, 40x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 82 of 110
83 Bone, vertebrae, T12, CT-guided FNA: Papanicolaou stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 83 of 110
84 Bone, vertebrae, T12, CT-guided FNA: Papanicolaou stain, 40x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 84 of 110
85 Bone, vertebrae, T12, CT-guided FNA, Cell block, H & E stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 85 of 110
86 Bone, vertebrae, T12, CT-guided fine needle aspiration: Malignant tumor cells present derived from carcinoma. Comment: Immunohistochemical stains for CK 7, CK 20, p63 and TTF-1 are non- contributory. Morphologically, this tumor would be consistent with the patient s s clinical history of urothelial carcinoma. Clinical correlation recommended. Cell block and cytologic preparations examined. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 86 of 110
87 Bone, T12 vertebral body, left side, true cut biopsy: Chronic osteomyelitis. Comment: Sections show fragments of bone with diffuse fibrosis with plasma cells and lymphocytes in bone marrow spaces. Focal lymphoplasmocytic aggregate is identified. Polyclonal plasma cells are highlighted with Kappa and Lambda immunohistochemical stains. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 87 of 110
88 Bone, T12 vertebral body, biopsy: Hematoxylin and eosin stain, 20x Presentation material is for education purposes only. All rights reserved URMC Radiology Page 88 of
89 Bone, T12 vertebral body biopsy: 20 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 89 of 110 Kappa Immunostain, 20x
90 21 Bone, T12 vertebral body biopsy: Presentation material is for education purposes only. All rights reserved URMC Radiology Page 90 of 110 Lambda Immunostain, 20x
91 Bone, vertebral body, T12, biopsy: Changes suggestive of a previous fracture site. No malignancy identified. Presentation material is for education purposes only. All rights reserved URMC Radiology Page 91 of 110
92 Bone, vertebral body, T12, biopsy: 23 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 92 of 110 H & E stain, 20x
93 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 93 of 110
94 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 94 of 110
95 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 95 of 110
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97 Presentation material is for education purposes only. All rights reserved URMC Radiology Page 97 of 110
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