Epithelioid GIST can be tricky!

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#PathSky Large, left sided abdominal/retroperitoneal mass in an older adult. Spindle cell proliferation with associated inflammation. All the outside IHC were negative. What to do next? MDM2 FISH? NGS? Methylation?

Anastomosing hemangioma (kidney): Lobulated architecture with anastomosing, sinusoidal, capillary-sized vessels lined by hobnail endothelial cells with rare mitotic activity and no endothelial multilayering. Despite their complex appearance, they behave in a benign manner. PMID 19606014. #PathSky

#PathSky 43M, forearm mass. At first glance, it looks like some kind of inflammatory process, maybe a synovitis with plasma cells, fibrosis and foamy macrophages.

Intramucosal adenocarcinoma in Barrett. Architectural complexity, nuclear atypia with large nucleoli, and poorly formed glands. p53 shows null staining pattern, suggestive of biallelic inactivation of TP53, leading to complete loss of expression. #PathSky #GIPath

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Interval appendicitis: Crohn-like features (fissuring ulcers, granulomas, transmural lymphoid aggregates), xanthogranulomatous inflammation, fibrosis, giant cells, features mimicking mucinous neoplasm (extravasated mucin, goblet cell hyperplasia, etc). #PathSky

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Epithelioid GIST can be tricky, especially when metastatic, as it can present variable histomorphology (neuroendocrine-like, plasmacytoid, atypia, etc.) and aberrant staining patterns (e.g. keratin). This is a liver biopsy. #PathSky #GIpath