#ENTPath - Quick 'stainless' #PathBoardReview

First up: Maxillary mass

Answer 1:

Ameloblastoma. Common. Many variants but conventionally multilocular with "soap bubble' or "honeycomb appearance." Look for the reverse polarity of basal columnar cells (Vickers-Gorlin change) with subnuclear vacuolization. Different case for comparison:

Question 2: Lip mass

Answer 2:

Spiradenoma. Basophilic nodules in the dermis with biphasic appearance. Focal duct formation. Remember the overlap with cylindroma.

Question 3: Neck mass

Answer 3

Paraganglioma. Discussion in the tweet below. The pinned tweet on my profile dives deeper into SDH mutations. https://twitter.com/Dr_Brian_Cox/status/1291440947310419968

Question 4: Parotid mass, recent growth.

Answer 4

Carcinoma ex-pleomorphic adenoma. Malignant cells mixed with benign epithelial stromal components of PA. Note the mitoses, pleomorphism, and necrosis.

Question 5: Nasal cavity lesion

Answer 5

Pilomatricoma/Pilomatrixoma. Note the basaloid, epithelioid cells, the reparative giant cells, and the shadow or ghost cells.

Question 6: Mandibular cyst

Answer 6

Odontogenic keratocyst. Bonus points. If you see this with basal cell carcinoma, what syndrome are we potentially dealing with? Question/Answer: 7

Gorlin syndrome. Mutation in PTCH1 (9q22.3). Also associated with ovarian fibroma.

Question 8: Maxillary sinus mass

Answer 8:

Adenoid cystic carcinoma. Relatively bland basaloid cells surrounding ductal lumina containing blue mucinous material. Arranged in a cribriform pattern. Highly associated with perineural invasion and up to 70% can recur.

#pathboards #tweetorial #dermpath #entpath
@TristanRutland7 @ALBoothMD @PathDocBoston @ariella8 @TheKarenPinto @Sara_Jiang @AssaadAM @GeronimoJrLapac @SwikrityUMD @SanicaBheleMD @HeadandNeckPath @VandaTorousMD @kkuanMD @Gagandeepk5MD @pembeoltulu @SGottesmanMD @DrGeeONE

@SimonRoyMD Your rad canalicular adenoma inspired this little series. https://twitter.com/SimonRoyMD/status/1299335832269094912

For all of those who made it this far, check out some of the 'deeper' differential(s) from the expert Dr. Sadow @PathDocBoston on adenoid cystic and subtyping ex-PA. They are in the comments below the questions.