16 June 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Laboratory Administration & Management of Pathology Practices > Lean workflow / Six Sigma

An organized workspace with a space for all needed tools or materials for jobs done at the station readily allows one to identify when something is missing or out of place.

Contributed by Stephen J. Hardy, M.B.A.

Liver & intrahepatic bile ducts > Ductular reaction

The ductular profiles with complete and incomplete lumina at the portal – parenchymal interface are highlighted by CK19.

Contributed by Shahbaz Khan, M.D.

Skin nonmelanocytic tumor > Juvenile xanthogranuloma

Right leg, excision, juvenile xanthogranuloma, scattered Touton giant cells.

Contributed by Lamiaa Hamie, M.D., M.Sc. and Ossama Abbas, M.D.

Bladder, ureter & renal pelvis > Noninvasive papillary urothelial carcinoma high grade

High power showing architectural disorder, loss of polarity and nuclear pleomorphism in high grade papillary carcinoma.

Contributed by Michelle R. Downes, M.D.

Informatics, digital & computational pathology > Fluorescent microscopy applications

Interphase FISH showing translocation involving the EWSR1 gene at 22q12.

Contributed by Ruhani Sardana, M.B.B.S. and Anil Parwani, M.D., Ph.D., M.B.A.

9 June 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Salivary glands > Mucoepidermoid carcinoma

Solid areas of the tumor are formed by different proportions of epidermoid (squamous) cells (red arrow), mucus cells (green arrow) and intermediate cells (yellow arrow) (histopathology, H&E stain, 10x).

Contributed by Rema A. Rao, M.D. and Saeed Asiry, M.D.

Skin melanocytic tumor > Invasive melanoma

44 year old woman with 0.8 cm nodule on her back. Scanning magnification shows a nodular melanocytic proliferation with minimal junctional component (2x).

Contributed by Michele Donati, M.D.

Skin nonmelanocytic tumor > Keratoacanthoma

An endophytic squamous proliferation with central crater filled with keratin.

Contributed by Poonam Sharma, M.B.B.S.

Bladder, ureter & renal pelvis > Urothelial carcinoma – invasive > Nested

Anastomosing, irregular, large nested and inverted growth of cytologically bland urothelium with desmoplastic stromal reaction (4x).

Contributed by Megan L. Brown, M.D. and Maria Tretiakova, M.D., Ph.D.

Esophagus > Ectopic sebaceous glands

Mature sebaceous gland within the lamina propria.

Contributed by Yukihiro Nakanishi M.D., Ph.D.

2 June 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Lung > Lepidic adenocarcinoma

Noninvasive lepidic adenocarcinoma (left) juxtaposed with adjacent uninvolved lung parenchyma (right). The lepidic adenocarcinoma is characterized by thickened alveolar septa lined by atypical overlapping cuboidal cells.

Contributed by Jonathan Keow, M.D., Ph.D.

Skin nonmelanocytic tumor > Trichilemmal (pilar) type cysts

High power view of epithelial lining with maturation of squamous epithelium, which lacks a granular layer (trichilemmal differentiation).

Contributed by Aaron Muhlbauer, M.D. and Jodi Speiser, M.D.

Skin nontumor > Granuloma annulare

Palisaded granuloma annulare. Arm of a 50 year old woman.

Contributed by Stephen Somach, M.D.

Vulva, vagina & female urethra > Smooth muscle tumors

Leiomyosarcoma of the vulva, morphologically low grade, with moderately atypical, round to cigar shaped nuclei with focally prominent nucleoli (400x). Mitoses are rare (1 – 2 per 10 high power fields) and necrosis is absent.

Contributed by David B. Chapel, M.D.

Penis & scrotum > Cutaneous verruciform xanthoma

A low power view shows papillary / verrucous epithelial hyperplasia with band-like plasma cell infiltrate in the scrotum.

Contributed by Liwei Jia, M.D., Ph.D.

Autopsy & forensics > Blunt force injuries

Anterior cranial base fractures (yellow arrows).

Contributed by Lorenzo Gitto, M.D., Robert Stoppacher, M.D., Serenella Serinelli M.D., Ponni Arunkumar, M.D. and Luigi Bonaccorso, M.D.

26 May 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Salivary glands > Intraductal carcinoma

Cuboidal cells with eosinophilic cytoplasm and small, oval nuclei and inconspicuous nucleoli (H&E, 40x).

Contributed by Kim A. Ely, M.D.

Soft tissue > Perineurioma

Soft tissue perineurioma showing hemangiopericytoma-like growth pattern (H&E, 12.5x).

Contributed by Andrea Saggini, M.D.

Stains & molecular markers > Microphthalmia associated transcription factor (MITF)

MITF highlights the nuclei of the pigmented spindle cells forming nests and fascicles.

Contributed by Ata Moshiri, M.D., M.P.H.

Stains & molecular markers > MCPyV (CM2B4)

The nuclear pattern of CM2B4 immunoreactivity in MCC tumor cells indicates MCPyV positivity. There is an absence of staining in the background nontumoral cells, including inflammatory, endothelial and stromal cells.

Contributed by Thai Yen Ly, M.D.

Ovary > Brenner tumor

This benign Brenner tumor features bland nuclei with conspicuous nuclear grooves in some tumor cells.

Contributed by Jutta Huvila, M.D. and C. Blake Gilks, M.D.

Lymphoma & related disorders > Lymphomatoid granulomatosis

Case 1: lung; H&E staining, Fig 2A: polymorphous infiltrate in scanner view (40x). Fig 2B: lymphocytic vasculitis with infiltration of the vessel wall is seen (100x). Fig 2C: lymphocytic vasculitis with infiltration of the vessel wall is seen (200x). Fig 2D: angioinvasion by lymphoid cells in lymphomatoid granulomatosis (400x).

Contributed by Nicholas Joseph Dcunha, M.B.B.S., M.D. and Elanthenral Sigamani, M.B.B.S., M.D.

19 May 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Lymphoma & related disorders > Large B cell lymphomas-special subtypes > EBV+

Low power view showing large transformed cells admixed with small lymphocytes.

Contributed by Sudhir Perincheri, M.B.B.S., Ph.D.

Lymphoma & related disorders > PTLD-polymorphic

400x magnification image demonstrating a polymorphic lymphoid infiltrate with full maturation, ranging from small, mature lymphoid cells to intermediate to large sized immunoblastic cells. Scattered plasma cells and eosinophils are also seen.

Contributed by Daniel Cassidy, M.D. and Jennifer Chapman, M.D.

Prostate gland & seminal vesicles > Adenosis / atypical adenomatous hyperplasia

Prostate, transurethral resection, adenosis. Medium power view of crowded, closely spaced acini lined by cells with clear cytoplasm and normal size nuclei (H&E, 20x).

Contributed by Cristina Magi-Galluzzi, M.D., Ph.D.

Salivary glands > Basal cell adenoma

Eosinophilic hyaline material is present in the tumor nest.

Contributed by Shuanzeng Wei, M.D., Ph.D.

Breast > Cytology

Ductal carcinoma in situ. Clusters of cytologic malignant cells with open chromatin (FNA, Pap stain, 20x).

Contributed by Areej M. Al Nemer, M.D.

12 May 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Breast > Invasive papillary carcinoma

Right breast, lumpectomy specimen showing invasive papillary carcinoma with desmoplastic reaction at the invasive tumor front without fibrous capsule (H&E, 10x magnification).

Contributed by Marilin Rosa, M.D.

Lymphoma & related disorders > Burkitt lymphoma

Burkitt lymphoma is the fastest growing human tumor. Ki67 positivity is approaching 100% (100x).

Contributed by Saja Asakrah, M.D.

Lymphoma & related disorders > Sézary syndrome

The touch imprint of a lymph node biopsy shows infiltration by small and atypical lymphocytes with cerebriform nuclei and scant cytoplasm.

Contributed by Roberto N. Miranda, M.D.

Lymphoma & related disorders > Associated with primary immune disorders

Reactive lymphoid aggregate in GI biopsy of an IgA deficiency patient, H&E 100x.

Contributed by Jinjun Cheng, M.D., Ph.D.

Salivary glands > Secretory carcinoma

Secretory carcinoma with follicular architecture showing abundant pale eosinophilic colloid-like secretions.

Contributed by Ruta Gupta, M.B.B.S., M.D.


How can you search the textbook?

For desktop / tablet, you can either use the Google search bar in the upper right corner or visit PathologyOutlines.com and then scroll down to where the 59 chapters are listed, as demonstrated below.

For mobile, visit PathologyOutlines.com, click on “Chapters by Subspecialty” (as demonstrated below) and then click on the subspecialty, chapter and topic.

For any device you can use your favorite browser and type in PathologyOutlines.com in addition to the search term.

5 May 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Bone & joints > Chondrosarcoma (primary, secondary, periosteal)

There is obvious nuclear atypia and pleomorphism but the background is distinctly chondroid.

Contributed by Shadi Qasem, M.D.

Bone marrow neoplastic > Myeloid / lymphoid neoplasms with eosinophilia and gene rearrangement > PCM1-JAK2

Bone marrow clot showing large, abnormal aggregate of early erythroid precursors. Also note dysplastic megakaryocytes (H&E stain, 200x).

Contributed by Zeba N. Singh, M.B.B.S., M.D.

Lymphoma & related disorders > Indolent T lymphoproliferative disease of the GI tract

Majority of T cells in the infiltrate are CD8 positive.

Contributed by Anamarija M. Perry, M.D.

Uterus > Leiomyoma-general > FH deficient leiomyoma

Spindle or epithelioid cells with ovoid nuclei and prominent eosinophilic nucleoli surrounded by perinucleolar halos.

Contributed by Sabrina Croce, M.D., Ph.D.


How can you search the textbook?

For desktop / tablet, you can either use the Google search bar in the upper right corner or visit PathologyOutlines.com and then scroll down to where the 59 chapters are listed, as demonstrated below.

For mobile, visit PathologyOutlines.com, click on “Chapters by Subspecialty” (as demonstrated below) and then click on the subspecialty, chapter and topic.

For any device you can use your favorite browser and type in PathologyOutlines.com in addition to the search term.

28 April 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Ovary > Mucinous borderline tumor / atypical proliferative mucinous tumor

Multiloculated cyst with mucinous contents and smooth external surface.

Contributed by Russell Vang, M.D.

Placenta > Decidual arteriopathy

Advanced decidual arteriopathy with fibrinoid necrosis. Arteries are distended and show endothelial injury (detachment from the wall, arrow) and fibrinoid necrosis of the media (*). 200x original magnification.

Contributed by Jonathan L. Hecht, M.D., Ph.D.

Breast > Tubular adenoma

Eosinophilic secretions present in the lumens of some of the tubules (H&E, 20x magnification).

Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.

Breast > Metaplastic carcinoma

Moderate to markedly cytologic atypia and frequent mitosis (200x).

Contributed by Huina Zhang, M.D., Ph.D.

Placenta > Maternal vascular malperfusion

Infarction (fresh): infarcts are typically pyramidal shape and involve the maternal floor of the placenta. Older infarcts are white, while more recent infarcts are red / heterogeneous in the fresh state.

Contributed by Jonathan L. Hecht, M.D., Ph.D.

Salivary glands > Acinic cell carcinoma

Parotid gland FNA of acinic cell carcinoma. The neoplastic cells are large with abundant finely vacuolated to granular cytoplasm (Diff-Quik).

Contributed by Arash H. Lahouti, M.D.


How can you search the textbook?

For desktop / tablet, you can either use the Google search bar in the upper right corner or visit PathologyOutlines.com and then scroll down to where the 59 chapters are listed, as demonstrated below.

For mobile, visit PathologyOutlines.com, click on “Chapters by Subspecialty” (as demonstrated below) and then click on the subspecialty, chapter and topic.

For any device you can use your favorite browser and type in PathologyOutlines.com in addition to the search term.

21 April 2021: Pathology Images of the Week

Here is a selection of new images from our free, online textbook:

Kidney nontumor > Acute pyelonephritis

Acute inflammation / pus in renal calyx.

Contributed by Jian-Hua Qiao, M.D.

Liver & intrahepatic bile ducts > Combined hepatocellular carcinoma-cholangiocarcinoma

Unequivocal cholangiocytic (red arrow) and hepatocytic (blue arrow) areas of cell differentiation. The hepatocytic area shows tumor cells organized in trabeculae (H&E 100x).

Contributed by Aurélie Beaufrère, M.D.

Bone marrow neoplastic > Myeloid neoplasms with germline predisposition and other organ dysfunction with GATA2 mutation

Bone marrow core biopsy of the same patient shows megakaryocytic dysplasia (small, hypolobated) (H&E, 40x).

Contributed by Wei Wang, M.D., Ph.D.

CNS tumor > Pituicytoma

Nuclear expression of TTF1 is ubiquitous.

Contributed by Federico Roncaroli, M.D.

Muscle & peripheral nerve nontumor > Immune mediated necrotizing myopathy

Thigh muscle from a 49 year old woman with progressive proximal weakness and creatine kinase in the 7,000s. Histology shows a pauci-inflammatory IMNM. The necrotic fibers are randomly distributed and temporally heterogeneous. There is also moderate fiber size variation and frequent internalized nuclei, suggesting that myofiber damage has been going on for a while (H&E, 20x).

Contributed by Chunyu “Hunter” Cai, M.D., Ph.D.


How can you search the textbook?

For desktop / tablet, you can either use the Google search bar in the upper right corner or visit PathologyOutlines.com and then scroll down to where the 59 chapters are listed, as demonstrated below.

For mobile, visit PathologyOutlines.com, click on “Chapters by Subspecialty” (as demonstrated below) and then click on the subspecialty, chapter and topic.

For any device you can use your favorite browser and type in PathologyOutlines.com in addition to the search term.

14 April 2021: Images of the Week

Here is a selection of new images from our free, online textbook:

Skin nonmelanocytic tumor > Atypical fibroxanthoma

Cytomorphologically, lesional cells are highly bizarre and atypical, with marked pleomorphism in size and shape, abundant eosinophilic cytoplasm, occasional multinucleation and numerous mitotic figures, including atypical forms (H&E, 200x).

Contributed by Pavandeep Gill, M.D. and Phyu Aung, M.D., Ph.D.

Stomach > Fundic gland polyp

Cystically dilated glands.

Contributed by Naziheh Assarzadegan, M.D.

Appendix > Enterobius vermicularis

Higher magnification shows Enterobius eggs with 1 flattened side and 1 convex side and a double layer hyaline chitin shell.

Contributed by Eiman Adel Hasby, M.D.

Bone marrow neoplastic > Atypical chronic myeloid leukemia

Bone marrow biopsy from a patient with aCML showing markedly hypercellular bone marrow with markedly increased neutrophils and myeloid precursors and mild dysmegakarypoiesis with no increase in blasts.

Contributed by Ling Zhang, M.D.

Esophagus > Undifferentiated carcinoma

Undifferentiated carcinoma at high power. Sheets of clearly high grade cells without obvious pattern of differentiation into any given cell type.

Contributed by Rondell P. Graham, M.B.B.S.


How can you search the textbook?

For desktop / tablet, you can either use the Google search bar in the upper right corner or visit PathologyOutlines.com and then scroll down to where the 59 chapters are listed, as demonstrated below.

For mobile, visit PathologyOutlines.com, click on “Chapters by Subspecialty” (as demonstrated below) and then click on the subspecialty, chapter and topic.

For any device you can use your favorite browser and type in PathologyOutlines.com in addition to the search term.