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National Renal Pathology E.Q.A. Scheme

Circulation H


This document gives information on individual cases in circulation H of this scheme. It contains no personal details of participants.

Cases included:

H 182
H 183
H 184
H 185
H 186
H 187
End


A click on the {Image} icon should provide an image from the material circulated. Some of the images are composites - remember to scroll the image to see parts beyond the bottom of your screen.

WARNING The image files associated with this document are selected by the Organiser in an attempt to illustrate the relevant features of the material which was circulated in the EQA scheme. They are intended as an 'aide memoire' for participants who may no longer have the slides for review.

They are NOT intended as 'good examples' or as teaching material. Some of the images may be chosen to illustrate a feature which led some participants to a wrong diagnosis.


Case Response Analysis

Circulation: H

Case number: 182 .... {Image}


Number of responses:74 . Date of analysis: 11 JUL 02

Clinical:

Female, 30 years old. Acute renal bleed, Hb down to 6. CAT- large haematoma lower pole L kidney. Tumour circulation on angiogram.

Specimen:

Nephrectomy for tumour

Macro:

Large haematoma round pale tumour 5cm in diamter, lower pole. Uninvolved kidney grossly normal. Supplied H&E of tumour edge; images of CAM5.2 and HMB45.
Diagnostic categories:                         Score:
 1  Angiomyolipoma                                          9.93
 2  Clear cell sarcoma                                      0.07

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.93

Secondary diagnoses and comments (if any):

History to exclude malignancy*1. Tuberose sclerosis?*8. Entrapped tubules noted*10. Angiomyo and clear cell sarcoma both HMB45 positive*1. Photos not received*2.

Original report and further information (if any):

Benign angiolipoma with entrapment of renal tubules at edges.


Circulation: H

Case number: 183 .... {Image}


Number of responses:75 . Date of analysis: 11 JUL 02

Clinical:

Male, 19y.o. Hypertension (160/100) and proteinuria 7g. found one year ago. Treated with ACE inhibitor. BP dropped to 140/90, proteinuria fell to 3.5g. Normal creatinine. Ultrasound of kidneys normal. IF: Granular capillary basement membrane IgG++ with C3+, some IgA in tubules. No EM.

Specimen:

H&E, PAS

Macro:

(Case from outside UK: This may or may not be relevant)
Diagnostic categories:                         Score:
 1  Membranous nephropathy                                  9.69
 2  Mesangiocapillary Gn                                    0.13
 3  Diabetic 'membranous Gn'                                0.17

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.69

Secondary diagnoses and comments (if any):

Segmental lesions present*13. Silver*19. EM*14. EVG*1. Secondary membranous?*10. Lupus serology?*8. Diabetes too?*2. Interstitial nephritis too*2. Inadequate mateial for EQA*4. Congo red*3. ?Sickle cell disease?* 1.

Original report and further information (if any):

Diffuse membranous nephropathy with segmental sclerotic changes, plus mild interstitial nephritis with eosinophils, possibly drug induced. 1 week later developed ARF with eosinophils in urine. Given steroids; renal function improved.


Circulation: H

Case number: 184 .... {Image}


Number of responses:75 . Date of analysis: 11 JUL 02

Clinical:

Male 41y.o. Four month history of proteinuria and microscopic haematuria. Hypertensive. Immunoperoxidase: Diffuse mesangial C3 and IgM; IgA section provided.

Specimen:

H&E, PA silver, IgA
Diagnostic categories:                         Score:
 1  IgA nephropathy                                         9.77
 2  FSGS                                                    0.16
 3  SLE                                                     0.07

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 9.77

Secondary diagnoses and comments (if any):

EM*6. EVG*1. Exclude lupus*3. WHO class III*1. Type 3*1. Hypertensive changes too*6.

Original report and further information (if any):

IgA nephropathy


Circulation: H

Case number: 185 .... {Image}


Number of responses:75 . Date of analysis: 11 JUL 02

Clinical:

female, 43. Heart transplant 8 years ago for cardiomyopathy. 3 week history of tingling in jaw. Platelets low, raised white cell count. Given Augmentin for one week. Decreased urine output noted, biopsy 1 week later. No NSAIDs given. Apologies for thin core.

Specimen:

H&E
Diagnostic categories:                         Score:
 1  Post transplant lymphoproliferative disorder            6.43
 2  Small cell carcinoma                                    0.03
 3  Leukaemic / lymphoma infiltrate NOS                     3.01
 4  Malignant infiltrate, need immuno.                      0.53

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 6.43

Secondary diagnoses and comments (if any):

Immuno for LCA*6, cytokeratin*2, lymphocyte type*33, K&L for clonality*9. In situ/PCR for EBER/EBV*26. c-myc*1. Poor mophology (+/- rude comments)* 17. Fixed in cold tea?*1. Should be education only*3.

Original report and further information (if any):

Post-transplant lymphoproliferative disease (PTLD).


Circulation: H

Case number: 186 .... {Image}


Number of responses:75 . Date of analysis: 11 JUL 02

Clinical:

21 y.o. male. Presented with acute abdominal pain and 'vasculitic' rash. Nephrotic range proteinuria, normal creatinine, low serum albumin, ascites and bilateral pleural effusions. IF: moderate amounts of IgA in the mesangium and capillary walls with smaller amounts of IgG and C3.

Specimen:

H&E, PAS
Diagnostic categories:                         Score:
 1  Henoch Schonlein Purpura                                8.53
 2  IgA nephropathy                                         0.89
 3  Mesangiocapillary Gn                                    0.17
 4  Diffuse endocapillary glomerulonephritis                0.27
 10 No response                                             0.13

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 8.53

Secondary diagnoses and comments (if any):

Lupus serology*2. Silver*5. EM*6. WHO IV*1. Type 4*1. Class IIIb*1. Circulating immune complexes?*1. Exclude infection*1.

Original report and further information (if any):

Proliferative glomerulonephritis with focal necrosis and crescent formation consistent with Henoch-Schonlein purpura.


Circulation: H

Case number: 187 .... {Image}


Number of responses:75 . Date of analysis: 11 JUL 02

Clinical:

20 y.o. female. Tonsillitis 5 weeks previously. Acute nephrotic syndrome with acute renal failure. IF: moderate to large amounts of IgG and IgM with C3 in granular pattern glomerular capillary walls.

Specimen:

H&E, PAS, EM*3
Diagnostic categories:                         Score:
 1  Post-strep. / endocapill. prolif. Gn                    8.08
 2  Acute diffuse proliferative Gn NOS                      0.79
 3  Lupus nephritis                                         0.24
 4  Mesangiocapillary Gn                                    0.89

Asterisks (if any) indicate dangerous diagnoses.     
Highest scoring diagnosis was 1 with 8.08

Secondary diagnoses and comments (if any):

Silver*4. ASOT*13. Lupus serology*9. Complement levels*2. C3nef*1. ?Family history*1. Odd distribution of EDDs*1. EM missing*3.

Original report and further information (if any):

Crescentic glomerulonephritis with background diffuse proliferative glomerulonephritis of endocapillary pattern


Links to cases in this document:
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H 182
H 183
H 184
H 185
H 186
H 187



Last updated: 11 JUL 02
Organiser: Professor Peter Furness, PhD, FRCPath. Clinical Sciences Laboratories
Leicester General Hospital
Gwendolen Road
Leicester
LE5 4PW, U.K.
Tel: (0116)2584582
Fax: (0116) 2584582

Email: peter.furness@le.ac.uk