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Scotland and Northern Ireland EQA Circulation 42 Cases A-E – Dr G Milne

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Page 1: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Scotland and Northern Ireland EQA

Circulation 42 Cases A-E – Dr G Milne

Page 2: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case A

Clinical History

• Female 41 years

• Complaining of IMB and PCB for several years

• Lesion on anterior lip of cervix biopsied ?HPV

Page 3: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
Page 4: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
Page 5: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Case A - Endometriosis

• 123 Responses

– 121 Cases Scored 1

– 2 Cases Scored 3

Page 8: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case A – Score 1

• ‘Endometriosis’

• ‘Cervical endometriosis’

Page 9: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case A – Score 3

• HGCGIN x 2

Page 10: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case B

Clinical History

• Male 36 years

• Lipoma of chest wall

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Case B - Angiolipoma

• 123 Responses

• 123 Cases Scored 1

Page 14: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case B – Score 1

• All answers – ‘Angiolipoma’

Page 15: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case C

• Male 73 years

• Temporal Artery Biopsy

Page 16: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Case C – Temporal Arteritis

• 123 Responses

• 123 Scored ‘1’

Page 20: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case C – Score 1

• ‘Temporal arteritis’

• ‘Giant cell arteritis’

• ‘Temporal/giant cell arteritis’

Page 21: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case D

• Female 44 years

• Raised erythematous lesion right lower lip

• 3 months duration

Page 22: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Page 25: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case D – Squamous cell carcinoma

• 123 Responses

• 120 Scored ‘1’

• 3 Scored ‘2’

Page 26: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Discussion – Score 1

• ‘Well differentiated SCC’

• ‘Moderately differentiated SCC’

• ‘Verrucous Carcinoma’

• ‘SCC + Probable vascular invasion’

• ‘SCC + Suggestive of lymphovascular invasion’

• ‘SCC - Need more history to excluded KA’

• ‘SCC - Need to see whole lesion to exclude KA’

Page 27: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Discussion – Score 2

• ‘Keratoacanthoma’ x 2

• ‘Keratoacanthoma – hard to diagnose without seeing whole lesion’

• Score 2 – fair?

• Subsequent excision biopsy showed dermal scarring and mild dysplasia only – no residual lesion

Page 30: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case E

• Female 26 years

• Soft tissue swelling middle finger, ?giant cell tumour

Page 31: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Case 5 – Giant cell tumour tendon sheath

• 123 Responses

• 123 Scored ‘1’

Page 35: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case 5 Discussion

• Answers scored ‘1’ –

Giant cell tumour of tendon sheath

Localised nodular tenosynovitis

Fibrous histiocytoma of tendon sheath

Giant cell tumour

Localised pigmented villonodular synovitis

Tenosynovial giant cell tumour

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End of Cases 1-5

Page 37: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

EQA Circulation 42

Cases F-J

Monica Agarwal

Monklands Hospital

Page 38: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

CASE F

• 62 year old female

• Right groin lymph node excision

• 3 cm lymph node

• ICC: CD20, CD10, BCL2 and BCL6 positive

Page 39: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Follicular lymphoma

• Total responses 122

• Score 1 – 122

• Grade of lymphoma was mentioned in some responses

Page 48: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case G

• 22 year old male

• Haematuria

• Diffuse white lesions in the bladder on cystoscopy

Page 49: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Schistosomiasis

• Total responses – 122

• Score 1 - 122

Page 53: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case H

• 57 year old female

• Colonic polyp received piecemeal

Page 54: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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Adenocarcinoma arising on background of an adenoma

• Total responses – 122

• Responses mentioning adenocarcinoma were scored 1

• Score 1 – 122

• Some of the responses also included subtype of adenoma

Page 58: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case I

• 43 year old female

• LLETZ

Page 59: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses
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High grade CGIN

• Total responses – 122

• Responses mentioning CGIN were scored 1

• Score 1 – 122

• Some responses further classified CGIN – low grade/high grade

Page 63: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

Case J

• 54 year old female

• Left submandibular gland excision for a 1.3 cm nodule

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Adenoid cystic carcinoma

• Total responses - 122

• Score 1 – 120

• Score 2 – 2

- Malignant salivary gland ?polymorphous low

grade ca – refer for expert opinion

- Salivary gland adenoca –D/D adenoid cystic ca and

polymorphous low grade adenoca –ICC and

specialist opinion required

Page 69: Scotland and Northern Ireland EQA Circulation 42 · PDF file•Soft tissue swelling middle finger, ?giant cell tumour . Case 5 – Giant cell tumour tendon sheath •123 Responses

THANK YOU


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