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Ankur Sangoi
@slusagar
, 9 tweets, 5 min read Read on Twitter
#GUpath puzzler time!
(for those of you familiar with this case, please keep 🤫!)

middle aged M found to have bilateral breast enlargement. Work-up revealed elevated serum PSA. MRI-guided prostate biopsy done of abnormal area seen on imaging.

🔬?🤔?
my DDx:
▶️Gleason 5+5 prostatic adenocarcinoma (for all new bx cases, I always do confirmatory prostate #IHCpath)
▶️plasmacytoid urothelial carcinoma
▶️signet ring GI tract adenocarcinoma
▶️metastatic lobular carcinoma
not shown but negative were:
NKX3.1/PSAP, CK20, uroplakin2
most folks were clued in about morphology of lobular carcinoma, which is partially CORRECT.

But something about this case bothered me...before calling the urologist to discuss the case, I did some searching around and 👀other cases my colleagues had the same day...
Dx: benign prostatic glands/stroma (tissue floater from another case of metastatic lobular carcinoma)
patient's bilateral breast masses you wonder? turns out he has gynecomastia, that's all 😳
but let's just say he had a clinically worrisome breast mass......

ideas on how we could sort out true metastatic ILC vs tissue floater?
bingo on the H3k27me3 #IHCpath idea! (stains Barr body)

end of #tweetorial #pathtweetorial
almost forgot:
have to give credit where credit is due 👉🏽first learned about the Barr body/H3K27me3 #IHCpath trick from @mlage's post here:

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