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353 Cards in this Set
- Front
- Back
Esophagus |
Reflux esophagitis -Arrow = basal hyperplasia -Circle = eosinophils -Arrowhead = lymphocytes (Also elongated vascular papillae) |
|
Espophagus |
Esophageal candidiasis -Tiny purple yeasts and pseudohyphae -Neutrophilic response |
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Esophagus |
Barrett esophagus -Columnar epithelium with goblet cells -Adjacent normal esophagus |
|
Esophagus |
HSV -Nuclear molding -Multinucleation -Nuclear margination |
|
Esophagus |
CMV -Infects mesenchymal cells at ulcer base -Intranuclear and cytoplasmic red/purple inclusions |
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Esophagus |
High grade dysplasia -Markedly hyperchromatic, pleomorphic, and disorganized nuclei -Cribiforming glands |
|
Esophagus |
Esophageal adenocarcinoma -As it becomes invasive gains nucleoli, which are not a feature of dysplasia |
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What anatomic region of the stomach? |
Antrum or Cardia - Normal astral mucosa - Thinner mucosa - Glands are mucinous |
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What anatomic region of the stomach? |
Fundus - Normal oxyntic mucosa - Thick mucosa that is mostly occupied by secretory glands - Shorter foveolar layer (arrow) |
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Stomach |
H. pylori gastritis - Lamina propria expanded with chronic inflammatory cells - Superficially oriented inflammation (PMNs) |
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Features of gastric MALToma? |
Sheets of monocytoid B cells (fried-egg appearance) Lymphoepithelial lesions (lymphs embedded in the epithelium) |
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Stomach |
Foveolar hyperplasia - Surface foveolar epith. has papillary appearance - Pits have a corkscrew pattern - Nuclei become hyperchromatic - Sm. musc. proliferates and stands between pits - Caused by chemical irritation |
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Stomach |
Autoimmune gastritis - Intestinal metaplasia in foveolar epith. (goblet cells) - Oxyntic type glands replaced by mucinous antral glands |
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Stomach |
Fundic gland polyp - Oxyntic-type glands with cystic dilation - Common in older people |
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Stomach |
Hyperplastic polyp - Hyperplastic, elongated, or cystic foveolar pits - Usually associated with background gastritis |
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Stomach |
Intestinal type adenocarcinoma Usually associated with atrophy and intestinal metaplasia |
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Stomach |
Diffuse type (signet ring cell) adenocarcinoma Easy to miss on low power |
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Stomach |
Gastrointestinal stromal tumor - Spindle cell neoplasm - c-kit (CD117) positive - Arises from interstitial cells of Cajal |
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Duodenum |
Chronic duodenitis - Gastric-type metaplasia (goblet cells replaced by foveolar epithelium) - Chronic inflammation in the lamina propria - Brunner gland hyperplasia (not pictured) |
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Duodenum |
Celiac disease - Villous blunting (looks like colonic mucosa) - Chronic inflammation in lamina propria - Intraepithelial lymphocytes |
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Duodenum |
Duodenal adenoma - Crowded and elongated nuclei - Loss of mucinous differentiation |
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Colon |
Tubular adenoma - Crowded and hyper chromatic nuclei - Loss of mucinous goblet cells |
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Colon |
Tubular adenoma (high-grade dysplasia) - Architectural diagnosis (glands become cribriform) |
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Colon |
Invasive adenocarcinoma - Causes desmoplastic response - Invasion beyond muscularis mucosa = malignant (invasion into LP = intramucosal carcinoma) |
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Colon |
Hyperplastic polyp - Frilly appearance |
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Colon |
Sessile serrated adenoma - Surface looks like hyperplastic polyp, but base shows sideways branching of crypts |
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Colon |
Carcinoid tumor - Nests of cells with round and regular nuclei with finely speckled chromatin |
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Features of active colitis |
1. Neutrophils in the crypt epithelium (cryptitis) 2. Neutrophils in the crypt lumen (crypt abscess) 3. Erosions, ulcers, and pus |
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Features of chronic colitis |
1. Crypt distortion 2. Crypt loss 3. Crypt atrophy 4. Paneth cell metaplasia |
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Colon |
Crohn's disease - Given away by granuloma - A definitive diagnosis of IBD requires features of chronicity |
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Colon |
Collagenous colitis - Predominantly women - Thickened collagen band alone the basement membrane - Top heavy lymphocytic infiltrate |
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Colon |
Lymphocytic colitis - Top heavy lymphocytic infiltrate |
|
Liver |
Mallory bodies -Irregular worm-like pink blobs of condensed cytoskeleton - Associated with alcoholic hepatitis |
|
Liver |
Congenital biliary atresia 1. Bile stasis 2. Acute inflammation 3. Proliferation of poorly formed bile ductules 4. Fibrosis |
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Liver |
Acute rejection - Lymphocytic destruction of portal vein and ducts - Occurs 5-30 days after transplantation |
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Changes associated with chronic liver transplant rejection |
Ductopenia and fibrosis without inflammation |
|
Liver |
Primary biliary cirrhosis - Portal lymphocytic inflammation - Arrow = lymphocytic destruction of bile duct - Curved arrow = granuloma formation |
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Liver |
Primary sclerosing cholangitis - Concentric bile duct fibrosis (onion skin) |
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Histologic picture of focal nodular hyperplasia |
Island of cirrhosis occurring in the background of a non cirrhotic liver |
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|
Well-circumscribed liver neoplasm with bland-looking hepatocytes with no central veins or bile ducts? |
Hepatic adenoma (there will be diffuse prominent arterioles) |
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Liver |
Bile duct adenoma -benign tangle of proliferating bile ducts |
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Liver |
Cholangiocarcinoma - Nondescript adenocarcinoma - Causes a intense desmoplastic response |
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Liver |
Cavernous hemangioma |
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Liver |
Angiosarcoma |
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What features distinguish chronic pancreatitis from pancreatic adenocarcinoma? |
Image is chronic pancreatitis 1. Lobular architecture with large central ducts surrounded by smaller peripheral ones = benign 2. 4:1 rule - in one gland, if one nucleus is four times the size on another, it is cancer 3. If lumens are incomplete and not symmetrically surrounded by nuclei, it is cancer 4. Perineurial invasion always indicates cancer *** Islets of Langerhans can look like cancer in chronic pancreatitis because they look crowded, infiltrative and haphazard |
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Pancreas |
Pancreatic adenocarcinoma |
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Pancreas |
Pancreatic intraepithelial neoplasia 1 (PanIN 1) - Tall mucinous cells resembling endocervix |
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Pancreas |
Pancreatic intraepithelial neoplasia 2 (PanIN 2) - Nuclear crowding, enlargement, and atypia |
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Pancreas |
Pancreatic intraepithelial neoplasia 3 (PanIN 3) - Loss of polarity - Frequent mitosies - Loss of mucin - Cribriform, papillary, micropapillary, or necrotic |
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Pancreas |
Intraductal papillary mucinous neoplasm - Graded as low-grade, moderate, and high grade with same criteria as PanIN 1,2,3 respectively - Often has blue mucin within the lumen of the duct - Grossly/radiologically visible (PanIN is not) |
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Pancreas |
Mucinous cystic neoplasm - Lining is composed of mucinous cells - Underlying stroma is blue, spindly, and looks like ovarian stroma |
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Pancreas |
Solid pseudopapillary tumor - Rosette-like growth around fibrovascular cores with dropout of intervening cells - Cystic lesion in young women |
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Pancreas |
Islet cell tumor - Round uniform cells with round uniform nuclei - Neuroendocrine type chromatin |
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What are low power features of prostate cancer? (8) |
1. Small individual glands infiltrating among larger benign glands (GP 3) 2. Crowded glands (intermediate grade) 3. Cellular infiltrate (GP 5) 4. Cribiform areas (high grade) 5. Sheets of cells (high grade) 6. Denser and bluer texture of glands 7. Blue mucin, crystalloid, or pink secretions in the lumen 8. Absence of desmoplastic response |
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Low power features of benign prostate glands? (3) |
1. Irregularly shaped glands with papillary infoldings (frilly) 2. Glands with a modest amount of intervening stroma 3. Corpora amylacea |
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High power features of prostate cancer (5) |
1. Larger, cherry-red nucleoli 2. Straight, crisp luminal borders to the glands 3. Enlarged and/or hyperchromatic nuclei 4. Lack of basal cell layer (identified by p63) 5. Mitoses (uncommon) |
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Prostate |
Adenocarcinoma Gleason Pattern 3 Straight luminal borders Relatively dense cytoplasm No basal layer |
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Prostate |
Adenocarcinoma Gleason Pattern 3 Malignant glands infiltrating among larger benign glands Denser, bluer cytoplasm |
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Prostate |
Adenocarcinoma Gleason Pattern 4 Fused pattern |
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Prostate |
Adenocarcinoma Gleason Pattern 4 Poorly formed glands |
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Prostate |
Adenocarcinoma Gleason Pattern 4 Cribriform pattern |
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Prostate |
Adenocarcinoma Gleason Pattern 3+4 |
|
Prostate |
Benign prostate -Irregularly shaped glands with papillary infoldings -Corpora amylacea -Modest amount of intervening stroma |
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Prostate |
Prostate adenocarcinoma with perineural invasion |
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Features that should be mentioned in a prostate cancer diagnosis (4) |
1. Number of involved cores 2. Percent involvement on each core 3. Perineural invasion 4. Extraprostatic extension (into the fat) |
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Features of high grade prostatic intraepithelial neoplasia (5) |
1. Glands are large with prominent papillary or micropapillary luminal surfaces 2. Glands appear denser and more blue than surrounding glands 3. Nuclei are enlarged and hyperchromatic 4. Nucleoli are visible at 20x 5. Basal cell layer is still present |
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Prostate |
Prostatic intraepithelial neoplasia high grade 1. Glands are large with prominent papillary or micropapillary luminal surfaces 2. Glands appear denser and more blue than surrounding glands 3. Nuclei are enlarged and hyperchromatic 4. Nucleoli are visible at 20x 5. Basal cell layer is still present |
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Prostate |
Adenosis Lobular group of crowded glands (may include small suspicious-looking glands, but don't have definitive malignant morphology) |
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Prostate |
Atrophy Hyperchromatic cells with attenuated cytoplasm Angular staghorn glands |
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Prostate |
Basal cell hyperplasia Proliferation of basal cells Cells look suspicious because they have prominent nucleoli, but have similar features as basal cells of surrounding normal glands |
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Prostate |
Cowper's glands Normal benign glands Mucous-filled secretory glands Lobular architecture Small bland nuclei |
|
Prostate |
Radiation atypia -Nuclei are too pleomorphic to be cancer -Enlarged nuclei have dense, uniform, smudgy chromatin |
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Prostate |
Seminal vesicle -Very pleomorphic nuclei -Telltale golden globs of lipofuscin |
|
|
Mimickers of prostate adenocarcinoma (7) |
1. Adenosis 2. Atrophy 3. Basal cell hyperplasia 4. Cowper's glands 5. Radiation changes 6. Sclerosing adenosis 7. Seminal vesicles |
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Bladder |
Von Brunn's nest and cystitis glandularis -Von Brunn's nests are downward invaginations of the urothelium ino the lamina propria -The nests may acquire a dilated central lumen with columnar cell metaplasai (cystitis glandularis) |
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Bladder |
Urothelial CIS - Nuclear enlargement - Hyperchromatic nuclei w/ irregular outlines - Denuded urothelium (not pictured) - Does not require full thickness involvement |
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Bladder |
Urothelial papilloma - Prominent fibrovascular core - Urothelium shows no dysplastic change |
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Bladder |
Papillary urothelial neoplasm of low malignant potential (PUNLMP) - Increased thickness - Cells remain uniform and organized |
|
Bladder |
low grade papillary urothelial carcinoma - Fibrovascular cores - Thickened urothelium that is increasingly disorganized - Enlarged nuclei |
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Bladder |
High grade papillary urothelial carcinoma - Large, dark, pleomorphic nuclei to the surface - Very disorganized urothelium - Mitoses seen at all levels - Can have nonurothelial differentiation |
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Bladder |
Invasive urothelial carcinoma |
|
Bladder |
Reactive urothelial atypia Enlarged nuclei Prominent nucleoli Smooth nuclear outline Pale, even chromatin |
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Bladder |
Nested transitional cell carcinoma Can look like Von Brunn's glands - Has a more infiltrated pattern at the base - Architecturally complex pattern with closely packed small nests |
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Bladder |
Lymphoepithelial-like carcinoma -Sheets of lymphocytes with carcinomatous cells that fade into the background -Nuclei are large and bubble with syncytial cytoplasmic borders |
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Kidney |
Cystic nephroma - Lined with a thin layer of cuboidal cells - Adjecent spindly stroma, similar to ovarian stroma |
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Kidney |
Angiomyolipoma -Large, tangled, tortuous, thick-walled hyalinized vessels -Smooth muscle cells that seem to spin off the vessel walls -Mature fat cells -Positive for HMB-45 and Melan-A |
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Kidney |
Mixed epithelial stromal tumor - Bland tubules of varying shapes and sizes set in a background of bland spindled stroma - May be solid or cystic - Estrogen and progesterone receptor positive stroma |
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Features of adrenal cortex clear cells |
Vacuoles that indent the nucleus giving it a stellate outline |
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Kidney |
Renal cell carcinoma, clear cell type - Net-like array of delicate capillaries, dividing cells into packets - Delicate, distinct cell membranes - Lack of desmoplasia |
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|
Furhman grading for RCC |
Done at 10x Grade I: nuclei resemble lymphocytes, no nucleoli (rarely used) Grade II: nuclei still small and without nucleoli, but with open chromatin Grade III: easily recognizable nucleoli, larger nuclei Grade IV: pleomorphic and hyperchromatic nuclei with big nucleoli |
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Kidney |
Renal cell carcinoma, chromophobe type - Distinct cell membranes - Cells of varying sizes and shapes - Pink & granular cytoplasm with perinuclear clearing - Koilocytic looking nuclei - Cytoplasmic positivity for Hale's colloidal iron |
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Differential for kidney tumor with pink cells (5) |
1. Chromophobe RCC 2. High-grade conventional RCC 3. Oncocytoma 4. Papillary RCC 5. Collecting duct carcinoma |
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Kidney |
Oncocytoma - Pink, granular cytoplasm - Nuclei are round, uniform, and evenly spaced - No perinuclear halos |
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Kidney |
Papillary RCC -Cuboidal to columnar pink cells - Central cores packed with foamy histiocytes |
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Kidney |
Collecting duct carcinoma - Looks like and behaves like adenocarcinoma - Desmoplastic response - Stains for mucin and CEA |
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Kidney |
Metanephric adenoma - Blue cell benign tumor of the kidney - Circumscribed tumor of monotonous, tightly packed, dense blue cells - Pattern ranges from tiny tubules to serpiginous gland-like structures |
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Kidney |
Wilms tumor - Triphasic histology (blastema, stroma, epithelium) - Defined as favorable or nonfavorable based on the presence of anaplasia |
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Testis |
Normal seminiferous tubule - Periphery: large spermatogonia with clear present - Plump pink Leydig cells in the interstitium - Tiny spermatids on the luminal side |
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Testis |
Normal rete testis Slit-like channels with cuboidal epithelium |
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Differential for male infertaility |
1. Aplasia (total lack of germ cells) 2. Hypospermatogenesis (decreased spermatogenesis in most tubules) 3. Maturation arrest (no spermatids produced) 4. End-stage testis (global sclerosis and atrophy) 5. Distal obstruction (shows normal spermatogenesis) |
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Testis |
Normal epididymis Columnar epithelium with cilia |
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Testis |
Sertoli-only syndrome aka aplasia -Tubules are lined with spindly Sertoli cells and no germ cells are visible |
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Testicular tumors of infants and children (2) |
Yolk sac tumor Teratoma |
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Testicular tumors of young adults and adults (4) |
Seminoma Embryonal carcinoma Choriocarcinoma Teratoma |
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Testicular tumors of older adults (3) |
Spermatocytic seminoma Lymphoma Sex cord stromal tumors |
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Testis |
Seminoma -Large, round, coarse nuclei that are nonoverlapping and nonmolding -One to two prominent nucleoli -Associated inflammation -Delicate branching fibrovascular septa -Surrounding intratubular germ cell neoplasia |
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Testis |
Intratubular germ cell neoplasia - CIS of the testis - Large cells with clear halos at the perimeter - Hyperchromatic and solid nuclei |
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Testis |
Spermatocytic seminoma - Most common GCT in adults - Indolent seminoma that does not metastasize - Has seminoma-like cells in small, medium, and large sizes - Lacks PLAP positivity (which distinguishes it from other germ cell tumors) - Not associated with IGCN |
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Testis |
Embryonal carcinoma - Looks epithelioid (like carcinoma) and stains positive with cytokeratin - Very pleomorphic - Hyperchromatic, angular, overlapping, or molding nuclei - Large nucleoli - Can be solid, glundular, or papillary |
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Testis |
Yolk sac tumor, microcystic type - Nuclei are smaller and more regular than embryonal carcinoma, but more atypical than seminoma - Most common testicular neoplasm in children |
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Testis |
Yolk sac tumor, reticular type - Nuclei are smaller and more regular than embryonal carcinoma, but more atypical than seminoma - Most common testicular neoplasm in children |
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Testis |
Choriocarcinoma - Contains two cell types (cytotrophoblast and syncytiotrophoblast) - Widespread mets are common - Cytotrophoblasts resemble embryonal carcinoma with smaller and less pleomorphic nuclei |
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Testis |
Mature teratoma - Elements of ectoderm, mesoderm, and endoderm - Benign in prepubertal boys - Malignant in postpubertal males and usually seen in the context of mixed GCTs |
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Testis |
Leydig cell tumor - Reminiscent of oncocytomas - 10% behave badly - Poor prognosis predicted by presence of atypia, mitotic rate, necrosis, vascular invasion, and extratesticular extension |
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Testis |
Sertoli cell tumor - This tumor attempts to recapitulate seminiferous tubules - Stroma may become hyalinized - 10% behave badly - Poor prognosis predicted by presence of atypia, mitotic rate, necrosis, vascular invasion, and extratesticular extension |
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Testis |
Testicular lymphoma - Usually diffuse large B cell |
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Ovary |
Primary ovarian follicle - Ovarian stroma is blue, cellular with a fascicular or storiform pattern - Central oocyte with a ring of granulosa cells |
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Ovary |
Corpus luteum Undulating layers of luteinized granulosa cells |
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Ovary |
Rete ovarii - Slit-like channels with a cuboidal cell lining - Vestigial structure found at the hilum of the ovary |
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Ovarian cyst |
Follicular cyst Lined by luteinized cells |
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Ovarian cyst |
Inclusion cyst Lined with attenuated epithelium |
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Surface epithelial tumors of the ovary (5) |
1. Serous 2. Mucinous 3. Endometrioid 4. Clear cell 5. Brenner or transitional |
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Sex cord stromal tumors of the ovary (3) |
1. Fibroma 2. Thecoma 3. Granulosa cell tumor |
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Ovarian neoplasm |
Borderline serous tumor - Complex architecture (papillary branching and invaginated folds), but not invasive - Lack significant atypia |
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Ovarian cyst |
Mucinous cystadenoma |
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Ovary |
Micropapillary serous carcinoma -Low-grade carcinoma characterized by a medusa-head pattern - When invasive, the tumor nests have a flower-like shape |
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Ovary |
Serous carcinoma Pleomorphic and darc cells Prominent nucleoli Glod in solid nests with slit-like spaces |
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Ovary |
Endometrioid carcinoma Nuclei are cleared out and pleomorphic Distinct glandular spaces |
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Ovary |
Clear cell carcinoma -Cells fall out of the center of nests creating a hobnail appearance -Fibrovascular septae - Grows in papillary, glandular, nested, or trabecular patterns |
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Ovary |
Brenner tumor Nests of transitional type epithelium in a fibrotic stroma |
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Ovary |
Immature teratoma - All teratomas must be carefully evaluated for immature elements - Most common immature tissue type is brain (hypocellular areas and dense small round blue cell areas) |
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Ovary |
Fibrothecoma Sheet-like pattern of bland spindled cells Tiny lipid vacuoles represent thecoma component |
|
Ovary |
Granulosa cell tumor Coffee bean nuclei Arranged in sheets with a zig zag pattern |
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Cervix |
Low grade intraepithelial lesion - Koilocytes have wrinkled, hyperchromatic nuclie wit ha perinuclear cleared halo - Mitoses should not be higher than the lower 1/3 |
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Cervix |
High grade intraepithelial lesion - Persistence of immature-appearing cells throughout the epithelium - High N/C ratios present from top to bottom |
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Cervix |
Squamous metaplasia - Well defined cell borders and low N/C ratio - Usually pinker than HSIL - Smooth round nuclei with even chromatin |
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Reactive changes in cervical epithelium (5) |
Regularly spaced and uniform nuclei Prominent nucleoli Nuclei have smooth contours Maturing upper layers without atypia Spongiotic edema |
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Cervix |
Placental site nodule -Dark nuclei and pink cytoplasm concerning for SCC -Nuclei are predominantly small and oval, wit ha few large nuclei visible |
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Cervix |
Microglandular hyperplasia - Proliferation of back-to-back glands lined with cuboidal or columnar cells with mucin vacuoles - Associated with OCPs |
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Cervix |
Endometriosis - Dark cuboidal lined gland resembling endometrial epithelium - Hemorrhage into endometrial-type stroma |
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Cervix |
Adenocarcinoma in situ - Close clusters of dark glands - Nuclei are tall and pseudostrafied - Ki67 elevated and p16 diffusely positive |
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Vulva |
Condyloma - Fibrovascular cores - Thickened and hyperkeratotic squamous epithelium |
|
Vulva |
Lichen sclerosus - Thin and atrophic epithelium - Dense, pale, homogenized collagen - Absent rete |
|
Vulva |
Extramammary Paget's disease Several nonsquamous cells visible within squamous epithelium |
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Endometrium |
Secretory endometrium -Cytoplasmic vacuoles -Tortuous glands -Stroma is edematous -Decidualization (accumulation of pink cytoplasm) begins around the spiral arteries. |
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Endometrium |
Proliferative endometrium - Short, straight, narrow glands - Compact stroma |
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Endometrium |
Progestin-treated endometrium - Stromal cells are deciualized - Epithelium is markedly thinned |
|
Endometrium |
Chronic endometritis - Diagnosed by presence of plasma cells - Stroma takes on a blue spindly look |
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Endometrium |
Acute endometritis - Diagnosis requires abscesses and destruction of glandular epithelium (neutrophils are a normal component of cycling endometrium) |
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Endometrium |
Disordered proliferative endometrium - Mixture of cystically dilated, budding, and tubular glands in a proliferative setting - Low gland density - Occurs with anovulatory cycles |
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Endometrium |
Endometrial polyp - Cystic dilation of glands - Secretory type epithelium - Thickened arteries |
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Endometrium |
Stromal breakdown - Stroma is condensed into a blue mass of tightly packed cells |
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Endometrium |
Simple hyperplasia Crowded tubular or minimally branched glands No atypia Gland-to-stroma ratio >1 |
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Endometrium |
Complex hyperplasia - Back-to-back glands with little stroma - Glands have branching outlines - Can occur with or without atypia |
|
Endometrium |
Complex atypical hyperplasia - Glands are irregular in size and shape - Atypica characterized by enlarged round nuclei, irregular chromatin distrubition, prominent nucleoli |
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Endometrium |
Endometrioid carcinoma - Most common endometrial cancer - Usually in postmenopausal women - Cribriform architecture |
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FIGO scores of endometrioid carcinoma |
FIGO 1: Tumor is <5% solid FIGO 2: Tumor is 6-50% solid FIGO 3: Tumor is >50% solid |
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Endometrium |
Serous carcinoma - High grade by definition - Papillary architecture - Extreme atypia - Cherry red nucleoli |
|
Endometrium |
Clear cell carcinoma - High grade by definition |
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Endometrium |
Malignant mullerian mixed tumor - Malignant glands in a sarcomatous stroma - Large angular pleomorphic nuclei in the stroma |
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Endometrium |
Leiomyosarcoma - >10 mitoses per HPF - Prominent cytologic atypia |
|
Placenta |
Placental membranes A = amnion B = artifactual space C = chorion D = underlying decidua |
|
Placenta |
Diamnionic, dichorionic placenta Amnion on both surfaces and a double layer of chorion sandwiched in the middle |
|
Placenta |
Diamnionic, monochorionic placenta No chorion is present between the layers of amnion |
|
Placenta |
Immature villi -Large in diameter -Double layer of cells lining the surface (cytotrophoblasts and syncytiotrophoblasts) -Blood vessels are not prominent |
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Placenta |
Mature villi -Villi are much smaller -Capillaries are more prominent -Syncytial knots -Fibrin knots |
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Umbilical artery |
Acute funisitis Neutrophils invading the muscle layer of the artery. This is a maternal response. |
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Placenta |
Acute chorioamnionitis |
|
Placental |
Meconiophages |
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Placenta |
Fibrinoid necrosis May be seen in preeclampsia |
|
Placenta |
Infarct Loss of nuclei and cell structure with mummified villi touching each other |
|
Placenta |
Partial molar villi Mixture of edematous villi and relatively normal villi |
|
Placenta |
Complete mole Large edematous villi and atypical trophoblastic proliferation |
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Breast |
Sclerosing adenosis -Tiny tubules entrapped in a fibrotic stroma -Looks infiltrative on high power -Myoepithelial cells can be highlighted by p63 -Circumscribed lesion at low power without desmoplastic response |
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Breast |
Fibroadenoma -Thin, branching ducts set in a sparsely cellular pale pink stroma - Proliferative stroma compresses ducts into slits |
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Breast |
Fat necrosis Foamy macrophages righ dead fat cells, diesting the lipid Spaces between fat cells are filled by fibrosis |
|
Breast |
Phyllodes tumor -More cellular stroma than fibroadenoma. -Graded by how the aggresive the stromal growth pattern is |
|
Breast |
Intraductal papilloma Proliferative secretory and myoepithelial cells lining a branching arbor of fibrovascular cores |
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Breast |
Usual ductal hyperplasia -Cell population is swirly and heterogenous with randomly overlapping nuclei -Peripheral ring of slit-like spaces |
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Breast |
DCIS, cribriform pattern -Monotonous clonal population of cells -Evenly spaced dark nuclei and distinct cell borders -Cribriform: sharply punched-out round holes, with cells lined up around the lumens like rosettes |
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Breast |
DCIS, high grade, comedo necrosis - High-grade loses its monotonous look, but still has discrete nonoverapping cells - Irregular nuclear borders, enlarged nuclei, and nucleoli |
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Breast |
Solid DCIS |
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Breast |
Micropapillary DCIS Top heavy lollipop protrusions into the lumen without true fibrovascular cores |
|
Breast |
Invasive ductal carcinoma Dense desmoplastic reaction Ugly cells radiate outward in a stellate pattern |
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Breast |
Invasive ductal carcinoma, tubular differentiation Well-differentiated cancer Bland small angular tubes Subtle desmoplastic reaction |
|
Breast |
Invasive ductal carcinoma, cribriform subtype |
|
Breast |
Invasive ductal carcinoma, mucinous subtype Pools of mucin with floating fragments of neoplastic epithelium |
|
Breast |
Invasive ductal carcinoma, medullary subtype Well-circumscibed ugly group of cells with dense lymphocytic infiltrate |
|
Breast |
Adenoid cystic carcinoma |
|
Breast |
Lobular carcinoma in situ -Monotonous cells with distinct borders and small round nuclei -Cytoplasmic vacuoles are typical -As the lesion expands, noncohesive cells fall apart -The cells fill and expand the lobules |
|
Breast |
Invasive lobular carcinoma -Small uniform cells with bland round nuclei -Single files of cells invading through stroma -Little to no desmoplastic response |
|
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What 3 factors influence the Elston grade? |
Tubule formation Mitotic rate Pleomorphism |
|
Lymph node |
Germinal center -Polarized such that centroblasts are at the bottom (denser and bluer area) -Mantle zone apparent at the top of the field |
|
Lymph node |
Diffuse large B cell lymphoma -Discohesive cells that do not form recognizable architectural patterns -Large nuclei with irregular and prominent nuclear membranes and nucleoli |
|
Lymph node |
Follicular lymphoma Lymph node diffusely replaced by follicles that lack mantle zones, polarization, and cell heterogeneity of germinal centers |
|
Lymph node |
Follicular lymphoma High power shows a mixture of small cleaved centrocytes and large centroblasts |
|
Lymph node |
Small lymphocytic lymphoma -Node diffusely replaced by blue homogenous appearance -Pale proliferation centers may be seen - CD5 and CD23 positive |
|
Lymph node |
Marginal zone lymphoma Monocytoid cells (rim of clear cytoplasm giving a fried-egg appearance) |
|
Lung |
Normal bronchus Ciliated columnar epithelium Foci of goblet cells Cartilage Smooth muscle |
|
Lung |
Normal bronchiole Lined by cuboidal epithelium and smooth muscle |
|
Lung |
Diffuse alveolar damage, exudative phase Interstitial edema and hemorrhage Hyaline membrane formation Type II hyperplasia Fibrin thrombi |
|
Lung |
Diffuse alveolar damage, organizing phase Fibroblast foci forming in alveoli and bronchioles Swirling nodules of stellate fibroblasts |
|
Lung |
Usual interstitial pneumonia -Temporally heterogenous (acute, subacute, and chronic phases of injury) -Interstital spaces are thickened and fibrotic -Airspaces are lined by plump type II pneumocytes -Diffuse chronic inflammation |
|
Lung |
Atypical adenomatous hyperplasia -Type II cell hyperplasia which appears as plump cuboidal to columnar eosinophilic cells with enlarged nuclei lining the airspaces. |
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Lung |
Squamous cell carcinoma Arises from squamous metaplasai, often in the major bronchi |
|
Lung |
Basaloid SCC Central necrosis is common Nests of very blue tumor cells with high N/C ratio and high mitotic rate |
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Lung |
Bronchoalveolar carcinoma Malignant cells line the alveolar walls but do not invade the stroma |
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Lung |
Small cell carcinoma Sheets of nuclei appear molded together with interlocking shapes due to near absence of cytoplasm. Neuroendocrine chromatin Mitoses and necrosis are common |
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Thyroid |
Hashimoto's thyroiditis - Lymphocytic infiltrate with germinal centers that displaces thyroid follicles |
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Thyroid |
Grave's disease -Follicles are large and distended with prominent papillary infoldings - Scalloping of the colloid |
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Thyroid |
Follicular adenoma -Solitary encapsulated nodule composed of small microfollicles with scant colloid -Round and monotonous nuclei -No crowding, overlapping, or irregular nuclei. |
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Thyroid |
Hurthle cell adenoma -Large pink oncocytes with round nuclei - Nuclei may be enlarged or irregular in shape (unlike follicular adenoma) |
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What is the defining feature of a follicular carcinoma? |
Capsular or vascular invasion |
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Thyroid |
Insular carcinoma -Cells grow in sheets and cords - Cells are round and uniform - Mitoses, necrosis, vascular invasion, and infiltrative growth is common |
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Neuroendocrine IHC markers (4) |
Synpatophysin (dense-core granules) Chromogranin (dense-core granules) Neural-specific enolase CD56 |
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Neuroendocrine architecture |
Nests, rosettes, and ribbons/trabeculae Prominent vascularity |
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Neuroendocrine neoplasm of pancreas |
Islet cell tumor |
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Neuroendocrine neoplasm of thyroid |
Medullary carcinoma |
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Neuroendocrine neoplasm of skin |
Merkel cell carcinoma |
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Neuroendocrine neoplasms of adrenal medulla and paraganglia (4) What is unique about the neuroendocrine tumors? |
Pheochromocytoma Paraganglioma (extraadrenal pheo) Neuroblastoma PNET These tumors are negative for cytokeratin |
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Distinguishing IHC feature of Merkel cell carcinoma |
CK20 stains as a punctate perinuclear dot |
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Utility of S100 stain in pheochromocytoma |
Highlights the Zellballen architecture by staining sustentacular cells. |
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What is the most important feature to distinguish neuroendocrine neoplasms from carcinomas? |
Morphology |
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What features are diagnostic for malignancy in neuroendocrine neoplasms? (3) |
Metastases Vascular invasion Invasion of adjacent organs (Only requires 1 of the 3) |
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Salivary gland |
Normal salivary gland -Secretory acini are arranged around round ducts (columnar epithelium) -In this image both serous and mucinous glands are present (typical of submandibular gland) |
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Salivary gland |
Interlobular duct Pseudostratified columnar epithelium |
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Types of salivary gland ducts (3) |
1. Intercalated ducts - low cuboidal epithelium (similar to bile ducts) 2. Striated ducts - pink columnar cells full of mitochondria and striated basal borders 3. Interlobular ducts - pseudostratified columnar epithelium with or without goblet and squamous metaplasia |
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Benign adenomas of salivary glands (and cell of origin) (3) |
1. Pleomorphic adenoma (epithelial-myoepithelial) 2. Basal cell adenoma (epithelial-myoepithelial) 3. Warthin's tumor (striated duct cell) |
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Low-grade malignant neoplasms of salivary glands (and cell of origin) (3) |
1. Low-grade mucoepidermoid carcinoma (interlobular duct cell) 2. Polymorphous low-grade adenoca. (epithelial-myoepithelial) 3. Acinic cell carcinoma (serous acinar cells) |
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Intermediate-to-high grade malignant neoplasms of salivary glands (and cell of origin) (3) |
1. Intermediate-to-high-grade mucoepidermoid carcinoma (interlobular duct cell) 2. Adenoid cystic carcinoma (epithelial-myoepithelial) 3. Adenoca. NOS (ducts) |
|
Salivary gland |
Pleomorphic adenoma -Encapsulated tumor -Mesenchymal component that is usually myxoid, but may be chondroid or osseous -Epithelial component that ranges from epithelial to myoepithelial |
|
Salivary gland |
Warthin's tumor - Cysts lined by a double layer of oncocytic cells overlying a dense lymphoid infiltrate |
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Oral lesion |
Lymphoepithelial cyst Differentiated from Warthin's tumor by ragged epithelial lining (rather than an oncocytic lining) |
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Salivary gland |
Mucoepidermoid carcinoma -Mixture of squamous cells, epithelioid cells, and clear mucinous cells -Recognizing intracellular mucin is key (PAS or mucicarmine stain helpful) |
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Features used to up-grade mucoepidermoid carcinoma (5) |
1. Percentage of cystic component 2. Anaplasia 3. Mitoses 4. Tumor necrosis 5. Neural invasion |
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Oral lesion |
Adenoid cystic carcinoma -Cribriform with sharply punched-out spaces full of secretions -High cellular denisty with high N/C ratio -Solid growth up-grades to high-grade |
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Salivary gland |
Acinic cell carcinoma -Cells maintain cytologic characteristics of serous acinar cells -Loses architectural pattern of normal salivary ducts -4 architectural patterns: solid, microcystic, papillary cystic, follicular |
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Oral lesion |
Polymorphous low grade adenocarcinoma -Epithelial component similar to pleomorphic adenoma -Infiltrates into normal tissue -Infiltrative cells spiral out of the central mass like a hurricane (reminiscent of lobular carcinoma) -Exclusively in intraoral minor salivary glands |
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DDx for infratentorial tumors in infants and young children (2) |
Pilocytic astrocytoma Medulloblastoma |
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DDx for infratentorial tumors in young adults (3) |
Pilocytic astrocytoma Ependymoma Medulloblastoma |
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DDx for infratentorial tumors in adults and elderly (3) |
Diffuse astrocytoma Hemangioblastoma Mets |
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DDx for cerebellopontine angle tumors in adults and elderly? (2) |
Schwannoma Meningioma |
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DDx for supratentorial tumors ininfants and young children? (1) |
Neuroblastoma (rare; usually an abdominal tumor) |
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DDx for supratentorial tumors in young adults? (4) |
Pilocytic astrocytoma Diffuse astrocytoma Ependymoma Pleomorphic xanthoastrocytoma |
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DDx for supratentorial tumors in adults and elderly? (5) |
Diffuse astrocytoma (esp. glioblastoma) Mets Meningioma Oligodendroglioma Lymphoma |
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DDx of sellar tumors in infants and young children? (1) |
Craniopharyngioma |
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DDx of sellar tumors in young adults? (3) |
Pituitary adenoma Craniopharyngioma Germ cell tumors |
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DDx of sellar tumors in adults and elderly? (2) |
Pituitary adenoma Papillary type craniopharyngioma |
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DDx of pineal tumors in infants and young children? (1) |
Pineoblastoma |
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DDx of pineal tumors in young adults (4) |
Germ cell tumors Pineoblastoma Pineal tumors Pineal cysts |
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DDx of pineal tumors in adults and elderly? (2) |
Pineal tumors Pineal cysts |
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DDx of intracranial ventricular tumors in infants and young children? (3) |
Ependymoblastoma Choroid plexus papilloma Choroid plexus carcinoma |
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DDx of intracranial ventricular tumors in young adults? (5) |
Choroid plesux papilloma Ependymoma Pilocytic astrocytoma Neurocytoma Subependymal giant cell astrocytoma |
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DDx of intracranial ventricular tumors in adults and elderly? (1) |
Subependymoma |
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DDx of dural based tumors in adults and elderly? (3) |
Meningioma Hemangiopericytoma Solitary fibrous tumor |
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Brain |
Astrocytoma, grade II -Fibrillary background -Scattered large nuclei with irregular shapes and coarse chromatin -Small microcysts |
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Brain |
Anaplastic astrocytoma Increased cellularity and mitotic activity compared to grade II astrocytoma. |
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Brain tumor |
Glioblastoma multiforme Pseuopalisading necrosis and microvascular proliferation |
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Brain |
Pilocytic astrocytoma -Fibrillary (hair-like) background -Scattered large dark nuclei -Rosaenthal fibers -Eosinophilic granular bodies |
|
Brain |
Reactive astrocytes -Dense pink cytoplasm and stubby processes -Gives a hypercellular appearance |
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Brain |
Oligodendroglioma -Closely packed cells with round nuclei surrounded by clear halos -Tumor cells are suspended in a network of fine capillaries (chicken wire) |
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Brain |
Meningioma, syncytial type -Most common type of meningioma -Nuclei are small, oval, and regular -Whorled architecture |
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Aggressive variants of meningioma |
Rhabdoid - plump pink cells with discrete cell borders Papillary - syncytial meningotelial cells on arborizing fibrovascular cores |
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Features that up-grade a meningiothelioma (5) |
1. Cellularity 2. Pleomorphism 3. Mitoses >4/HPF 4. Necrosis 5. Brain invasion |
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Brain |
Hemangiopericytoma Staghorn vessels in a background of small blue epithelioid to spindled cells |
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Brain |
Hemangioblastoma -Rare, associated w/ VHL syndrome - Packets of lipidized cells surrounded by interlacing and dilated capillaries |
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Brain |
Schwannoma -Alternating areas of high and low cellularity (Antoni A and Antoni B areas, respectively) -Antoni A areas show Verocay bodies |
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Brain |
Craniopharyngioma -Sheets of squamous cells with peripheral palisading -Stellate reticulum (loose meshwork of epithelial cells) -Wet keratin -Calcification (not pictured) |
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Brain |
Ependymoma Cells line up around vessels with cell processes extending to the vessel and the nuclei arranged around the perimeter (pseudorosette) |
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Brain |
Medulloblastoma Sheets of small blue cells with high N/C ratio, high mitotic rate, and necrosis Outside of the cerebellum this is called a PNET |
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Cytologic features of a melanocyte |
Rounded, pale-staining cells just above the dermis. |
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Skin |
Melanophages -Macrophages in the dermis with chunky globs of melanin |
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Skin |
Lentigo simplex -Linear proliferation of single benign melanocytes along the DE jxn |
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Skin |
Compound nevus -Nests of melanocytic cells attached to DE jxn -Nests of melanocytic cells dropping into the dermis -Cells in the deepesst point should appear slightly smaller and more bland than those at the DE jxn (maturation) |
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Skin |
Intradermal nevus - Dermal nests of nevus cells |
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Benign histologic features of melanocytic lesions (6) |
1. Symmetry 2. Size <3 mm in diameter 3. Lateral borders consisting of nests, not individual melanocytes 4. Lack of atypia in melanocytes (nuclei no larger than keratinocyte nucleus and small dense nucleolus) 5. Maturation into the dermis 6. Chunky brown-black pigment |
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Skin |
Blue nevus - Single dermal melanocytes that are elongated and fusiform or stellate - Do not make rounded nests |
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Skin |
Spitz nevus - Large nests of melanocytes found between skinny elongated rete - Found on the head and neck of children & adolescents |
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Features of architectural disorder in melanocytic lesions (4) |
1. Lentiginous spread of atypical melanocytes (along the DEJ in a creeping line) 2. Shouldering (lentiginous component wider than the dermal component) 3. Bridging of rete (nests attached to adjacent rete ridges fuse) 4. Fibroplasia (feathering of the dermal collagen that looks like pink cotton candy) |
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Features of cytologic atypia in melanocytic lesions (5) |
1. Hyperchromatic nuclei 2. Increased N/C ratio 3. Accumulation of dusty grey-brown melanin 4. Large red nucleoli 5. Atypical mitoses |
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Skin |
Dysplastic nevus - Bridging of rete - Dust grey-brown melanin - Prominent nucleoli - Hyperchromatic nuclei |
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Low power features of malignant melanoma (5) |
1. Asymmetry 2. Poorly circumscribed, pleomorphic, discohesive nests of melanocytes 3. Shouldering of atypical melanocytes 4. Pagetoid spread through the epidermis 5. Band-like lymphocytic inflammation |
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High power features of malignant melanoma (4) |
1. Atypia 2. Lack of deep maturation 3. Mitoses or atypia in the dermis 4. Melanocytic necrosis |
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Skin |
Malignant melanoma With conspicuous Pagetoid spread |
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Skin |
Malignant melanoma Lack of maturation Prominent nucleoli |
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Sign out criteria for melanoma |
1. Depth of invasion (Breslow's thickness) 2. Presence or absence of alceration 3. Margin status (deep and lateral) |
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Skin |
Solar Elastosis -Collagen is replaced by wispy gray-blue strands of elastin |
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Skin |
Solar lentigo (lentigo senilis) -Finger-like proliferation of hyperpigmented rete -Keratinocytes are the pigmented cells |
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Skin |
Actinic keratosis - Squamous atypia of varying thickness - Sparing of the keratin above hair follicles (alternating parakeratosis and orthokeratosis) -Underlying solar elastosis -Small buds of dysplastic buds extend into the papillary dermis |
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Skin |
Invasive squamous cell carcinoma - Penetration of nests deep in the dermis with deep keratinization |
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Skin |
Basal cell carcinoma - Lobules of small, blue, basal-type keratinocytes with peripheral palisading - Formation of clefts between tumor nests and stroma |
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Skin |
Seborrheic keratosis - Hyperkeratosis but no parakeratosis - Complicated pattern of intertwining rete and foci of trapped keratin (horn cysts) |
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Skin |
Verruca vulgaris -Striking epidermal proliferation ("church spires") -Overlying hyperkeratosis -Tips of spires often topped by parakeratosis |
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Skin |
Eccrine poroma -Continuous with epidermis (acrosiroma and hidradenoma are similar but deeper in dermis) -Cells that look similar to keratinocytes that try to form ducts -Cells are uniform, small, round, and pale -Similar appearance to florid ductal hyperplasia |
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Skin |
Eccrine spiradenoma -"Blue cannonballs in the dermis" -Consists of two basaloid cell lineages -Noticeable cords of hyaline basement membrane running through them |
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Skin |
Cylindroma -"Jigsaw puzzle pieces" -Basaloid blue nests in dermis -2 cell populations and basement membrane matrix |
|
Skin |
Syringoma - Round, dilated tubules in the dermis with tadpole appearance -Distinguish from microcystic adnexal carcinoma (malignant), which infiltrates deeply into the base |
|
Skin |
Microcystic adnexal carcinoma -Similar appearance to syringoma, except that it infiltrates deep in the dermis |
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Skin |
Dermatofibroma -Appears as ill-defined blue haze in the dermis -Made up of tiny swarming nondescript cells that infiltrate collagen -May have overlying hyperpigmented and hypertrophic epidermis |
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Skin |
Dermatofibrosarcoma Protuberans (DFSP) -Malignant counterpart of dermatofibroma -More cellular -Shows a prominent storiform pattern of spindled cells -Often infiltrates between fat cells |
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Skin |
Neurofibroma -Pale or grey nodule in the dermis, more defined than a dermatofibroma. -Displaces dermis rather than infiltrating it |
|
Skin |
Lobular capillary hemangioma (AKA pyogenic granuloma) - Many blood vessels with plump endothelium - Prominent inflammation |
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Describe features of a fibrosarcomatous high-grade sarcoma. (3) Seen in what sarcomas? (3) |
-Hypercellular -Fascicular with herringbone pattern -Atypia may not be significant Seen in -Fibrosarcoma -MPNST -Synovial sarcoma |
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Describe features of a malignant fibrous histiocytoma (pleomorphic undifferentiated sarcoma). (4) |
-Cellular tumor -Bizarre nuclear atypia (giant cells, highly pleomorphic, hyperchromatic nuclei) -Very mitotically active -Often with necrosis |
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Describe features of a myxoid malignant fibrous histiocytoma (myxofibrosarcoma). (4) |
-Myxoid or edematous background -Highly pleomorphic cells -Frequent mitoses -Arcing vessels |
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Describe features of leiomyosarcoma. (4) |
-Fascicular tumor with bundles of cells intersecting at right angles -High mitotic rate -Significant cytologic atypia -Not as pleomorphic as MFH |
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Describe features of rhabdomyosarcoma. (2) |
-Large eosinophilic cells with eccentric nuclei -Significant nuclear pleomorphism |
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Features of reactive fibroblasts |
-Large nuclei and prominent nucleoli that stand out against a pale nucleus -Nuclear membrane is smooth and oval -Seen in nodular fasciitis |
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Common benign neoplasms of fat (2) |
Lipoma Pleomorphic lipoma |
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Common variants of lipoma (6) |
Angiolipoma Angiomyolipoma Hibernoma Lipoblastoma (children) Myelolipoma Spindle cell lipoma |
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Common malignant but indolent neoplasms of fat (2) |
-Well-diferrentiated liposarcoma/atypical lipoma -Myxoid liposarcoma |
|
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Common malignant & aggressive neoplasms of fat (3) |
Dedifferentiated liposarcoma Round cell liposarcoma Pleomorphic liposarcoma |
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What cell is featured in the center of the field? |
Lipoblast - Central star-shaped nucleus indented by facuoles of fat |
|
Soft tissue mass |
Pleomorphic lipoma -Areas of nondescript spindle cells and collagen -Large giant cells and floret cells (wreath-shaped nuclei) -Found on the back or neck of elderly men |
|
Soft tissue mass |
Spindle cell lipoma - Bland spindle cells and collagen with intermixed fat cells -Found on the back or neck of elderly man |
|
Soft tissue mass |
Well-differentiated liposarcoma -Fibrous interstitium b/w fat cells -Fibrous areas have hyperchromatic, irregularly shaped nuclei visible at 4x -When in the retroperitoneum, may transform to dedifferentiated liposarcoma -When on extremities called "atypical lipoma", they have a better prognosis |
|
Soft tissue mass |
Mixoid liposarcoma -At low power it looks like a gelatinous tumor with scattered fat cells -Chicken-wire capillary network -Tumor cells are small spindled or rounded cells & lipoblasts -Can transform into higher grade round cell liposarcoma (cells are densely packed and obscure the vascular pattern) |
|
Soft tissue mass |
Nodular fasciitis -Fairly circumscribed with hypercellular periphery -Heterogeneous appearance -Microcystic appearance is classic -High power shows fusiform to stellate fibroblasts that float in a myxoid background (tissue culture appearance) |
|
|
Common benign fibrous and myxoid neoplasms (4) |
-Fibromatosis -Dermatofibroma/benign fibrous histiocytoma -Solid fibrous tumor -Intramuscular myxoma |
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Common malignant but indolent fibrous and myxoid neoplasms (6) |
-Low-grade fibromyxoid sarcoma ("Evans tumor") -Low-grade fibrosarcoma -Dermatofibrosarcoma -Atypical fibroxanthoma -Malignant solitary fibrous tumor -Low-grade myxofibrosarcoma |
|
|
Common malignant & aggressive neoplasms (2) |
Fibrosarcoma Myxofibrosarcoma (aka myxoid MFH) |
|
Soft tissue mass |
Fibromatosis -Bland tumor composed of normal-looking fibroblasts -Fascicles of pink cells with pale tapering nuclei in a collagenous background -Very infiltrative around the edges |
|
|
Staining pattern of solitary fibrous tumor |
CD34 CD99 bcl-2 |
|
Soft tissue mass |
Solitary fibrous tumor -Patternless pattern (nonstoriform-nonherringbone-nonfascicular) -Reminiscent of ovarian stroma, but more pink d/t abundant collagen -Staghorn vessels |
|
Soft tissue mass |
Myxofibrosarcoma -Prominently myxoid with higher cellularity, nuclear pleomorphism, and mitotic rate compared to myxoma -Characteristic vessels with short thick arcs (curvilinear) |
|
Soft tissue mass |
Inflammatory myofibroblastic tumor (IMT) -Plump fibroblasts -Associated inflammation, esp. plasmas (arrows) -Similar appearance as nodular fasciitis (tissue culture-like fibroblasts in a myxoid, granulation-like background) -Neoplasm of young people arising in the abdominal cavity |
|
Soft tissue mass |
Alveolar rhabdomyosarcoma -Fibrous septae divide tumor into packets -Cells are discohesive and fall apart in the middle of the packets |
|
Soft tissue mass |
Masson's tumor -Fibrin papillae covered by thin endothelium |
|
Soft tissue mass |
Epithelioid hemangioendothelioma -Sclerosing lesion -Cords of vacuolated cells, some of which contain RBCs (diagnostic feature) |
|
Soft tissue mass |
Angiosarcoma -Branching, anastomotic irregular spacces with bulbous atypical cells lining the spaces (hobnail pattern) -Infiltrative border |
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|
How are most soft tissues tumors of unknown differentiation defined? |
By their translocations |
|
Soft tissue |
Biphasic synovial sarcoma Gland-like spaces lined by CK+ epithelial cells with a background of spindle cells. |
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|
Morphologic features of monophasic synovial sarcoma. |
Blue, hypercellular, with a monomorphic population of nondescript spindle cells. |
|
Soft tissue mass |
Epithelioid sarcoma -Low power resembles a large granulomatous reaction w/ central geographic (continent-shaped necrosis) -Higher power shows tumor cells ranging from monomorphic spindle cells to large epithelioid cells w/ pink cytoplasm -Presents as ulcerated nodules on young men -Positive for vimentin and CK |
|
Soft tissue mass |
Alveolar soft part sarcoma -Translocation of TFE3 gene -Small packets divided by a capillary network -Large eosinophilic cells w/ round nuclei and prominent nucleoli |
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Common benign bone-forming tumors (3) |
Osteoma Osteoid osteoma Osteoblastoma |
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|
Common malignant but indolent bone-forming tumors (1) |
Parosteal osteosarcoma |
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|
Common malignant and aggressive bone-forming tumors (3) |
Osteosarcoma Periosteal osteosarcoma Telangiectatic osteosarcoma |
|
Bone mass |
Osteoid osteoma (or osteoblastoma if >1.5cm) -Osteoid in an interwoven lace-like pattern laid down by osteoblasts |
|
Bone mass |
Osteosarcoma Osteoid deposition with hyperchromatic and atypical osteoblasts |
|
|
Common benign cartilage-forming tumors (4) |
Osteochondroma Enchondroma Chondroblastoma Chondromyxoid fibroma |
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|
Common malignant cartilage-forming tumors (2) |
Chondrosarcoma Dedifferentiated chondrosarcoma |
|
Bone tumor |
Osteochondroma -Bony stalk in continuity with the main marrow space, capped by mature cartilage -Small risk of transformation |
|
Bone tumor |
Enchondroma Island of benign mature cartilage within the marrow space |
|
Bone tumor |
Chondroblastoma Benign tumor of cartliage with calcifaction that rings the lacunae giving a chicken wire pattern |
|
Bone tumor |
Chondrosarcoma Cartilage matrix resembles normal cartilage, but chondrocytes are pleomorphic |
|
Bony lesion |
Fibrous dysplasia -Lytic and fibrotic developmental abnormality -spindle cell population with a distinct pattern of thin, woven trabecular bone -Osteoblastic rimming is absent |
|
Bony lesion |
Ossifying fibroma -Lesion of the shins of young children -spindle cell population with intermixed thin, woven trabecular bone -Osteoblastic rimming is present |
|
Bone mass |
Giant cell tumor of bone -Mixture of osteoclast-like giant cells and mononuclear cells -Mitoses may be seen -Lytic and destructive lesion at the ends of long bones |
|
Bone mass |
Adamantinoma -Composed of squamous, fibrous, or adamantinomatous (like a developing tooth) cells - Do not call this metastatic carcinoma |
|
Bone mass |
Ewing's sarcoma -small round blue cell tumor involving bone -Classically positive for CD99 |
|
Joint lesion |
Giant cell tumor of tendon sheath, diffuse type -Villous or papillary mass of small bland cells, multinucleated giant cells, and foamy macrophages -Prominent cleft spaces sometimes with hemosiderin |
|
Nodular joint lesion |
Giant cell tumor of tendon sheath, nodular type (or nodular tenosynovitis) -Identical H&E appearance to diffuse giant cell tumor of tendon sheath -Distinguished by CD68 and clinical presentation |
