The 20th International Surgical Pathology Symposium addresses the unique challenges and problems encountered in today’s surgical pathology practice. The course simulates the daily activities of the practicing surgical pathologist. The conference offers the opportunity to review case histories, view slides by virtual microscopy and formulate a diagnosis. The unique subtleties and differentiating characteristics of each diagnosis are then highlighted. Faculty and participants also discuss the patient management strategy used in each case. The symposium format features three or four specialty areas each day. Throughout the four-day conference, 38 cases are presented and discussed. Faculty from Mayo Clinic’s Department of Laboratory Medicine and Pathology present cases in following specialty areas: breast, endocrine, genito-urinary, gynecologic, head and neck, pulmonary, and soft tissue pathology.