4 August 2021: Pathology Images of the Week

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

Lymphoma & related disorders > Prolymphocytic leukemia

Diffuse marrow involvement by medium to large sized cells with prominent nucleoli (200x, H&E).

Contributed by Richard K. Wood, M.D. and Dietrich Werner, M.D.

Ovary > Thecoma

Well circumscribed, firm, yellow-tan mass.

Contributed by Victoria Collins, M.D. and Tamara Kalir, M.D., Ph.D.

Prostate gland & seminal vesicles > Anatomy & histology

Here, the central zone cells are hyperplastic. Despite the cribriform structure, the bland nuclei rule out intraepithelial neoplasia or cribriform cancer. Also note the surrounding dense stroma of the central zone.

Contributed by Kenneth A. Iczkowski, M.D.

Prostate gland & seminal vesicles > Malakoplakia

Michaelis-Gutmann bodies highlighted by arrows.

Contributed by Theodorus van der Kwast, M.D., Ph.D.

Small intestine & ampulla > GIST

Small intestinal GIST with skeinoid fibers.

Contributed by Shefali Chopra, M.D.

28 July 2021: Pathology Images of the Week

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

Breast > Fibromatosis

Spindle cells appear bland with no mitotic activity.

Contributed by Carissa LaBoy, M.D.

CNS tumor > Diffuse leptomeningeal glioneuronal tumor

Tumor cells with a low grade, monomorphic appearance showing perinuclear haloes, reminiscent of oligodendroglioma (200x overall magnification).

Contributed by Katherine Schwetye, M.D., Ph.D.

Kidney nontumor > Congenital nephrotic syndrome

Prominent cystically dilated proximal and distal tubules with an attenuated epithelium (periodic acid-Schiff stain).

Contributed by Chunlai Zuo, M.D., M.S. and Jonathan E. Zuckerman, M.D., Ph.D.

Ovary > Serous cystadenoma / adenofibroma

Large serous cystadenoma with localized (less than 10% of sampled cyst wall) epithelial proliferation. No complex papillary growth is seen (H&E, 100x).

Contributed by Catherine J. Roe, M.D. and Krisztina Hanley, M.D.

Stains & CD markers > Special AT-rich sequence-binding protein 2 (SATB2)

Colon neuroendocrine tumor, well differentiated (SATB2).

Contributed by Sepideh Besharati, M.D.

21 July 2021: Pathology Images of the Week

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

Oral cavity & oropharynx > Lingual tonsil

The posterior lateral tongue contains 6 – 8 larger red papules.

Contributed by Molly Housley Smith, D.M.D.

Ovary > Corpus luteum cyst

Intermediate magnification showing bilayered cyst lining with inner granulosa cells (lower part of the image) and outer layer of theca cells (upper part of the image).

Contributed by Aurelia Busca, M.D., Ph.D.

Stains & CD markers > WT1

The tumor cells show strong nuclear positivity for WT1. The necrotic tumor cells lose antigenicity for WT1. The final diagnosis is WT1 positive malignant mesothelioma.

Contributed by Urooba Nadeem, M.D. and Aliya N. Husain, M.D.

Bone marrow neoplastic > Chronic neutrophilic leukemia

Peripheral blood smear shows leukocytosis where almost all the cells are mature neutrophils with normal morphology. It is characteristic of chronic neutrophilic leukemia that no (or at most < 5%) immature cells at earlier stage than neutrophils and bands are noted in the peripheral blood. The neutrophils show adequate segmentation and no dyspoietic features (Wright Giemsa, 400x magnification or 40x objective).

Contributed by Roberto N. Miranda, M.D.

14 July 2021: Pathology Images of the Week

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

Placenta > Exaggerated placental site

High power image of mononucleate and multinucleate intermediate trophoblasts containing abundant eosinophilic cytoplasm with hyperchromatic and irregular nuclei.

Contributed by Raavi Gupta, M.D. and Absia Jabbar, M.D.

Soft tissue > Inflammatory myofibroblastic tumor

Loosely arranged spindle cells growing in haphazardly arranged fascicles, interspersed by abundant chronic inflammatory cells (400x).

Contributed by Carina Dehner, M.D., Ph.D.

Thyroid & parathyroid > Langerhans cell histiocytosis

Thyroid gland, Langerhans cell histiocytosis: histiocytes with convoluted, folded nuclei and pale eosinophilic cytoplasm.

Contributed by Somboon Keelawat, M.D. and Jijgee Munkhdelger, M.D., Ph.D.

Appendix > Well differentiated neuroendocrine tumor

Low power image showing nested growth of tumor cells.

Contributed by Kwun Wah Wen, M.D., Ph.D.

Liver & intrahepatic bile ducts > Cirrhosis

Cut surface of a macronodular cirrhotic liver with multiple regenerative nodules.

Contributed by Anthony W.H. Chan, M.B.Ch.B.

7 July 2021: Pathology Images of the Week

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

CNS tumor > Papillary craniopharyngioma

Classic low power cauliflower-like configuration with smooth borders.

Contributed by Nelli S. Lakis M.D., M.Sc.

Nasal cavity, paranasal sinuses, nasopharynx > Sinonasal undifferentiated carcinoma

Sheets of undifferentiated malignant epithelial cells with vesicular nuclear chromatin and prominent nucleoli.

Contributed by Bin Xu, M.D., Ph.D. and Abeer Salama, M.D.

Placenta > Choriocarcinoma

Intraplacental choriocarcinoma showing atypical syncytiotrophoblast, cytotrophoblast and intermediate trophoblast adjacent to uninvolved chorionic villi (H&E, 200x).

Contributed by Tatyana Zinger, D.O.

Small intestine & ampulla > Heterotopic gastric mucosa

Polypoid lesion predominantly lined by gastric foveolar epithelium and small intestinal epithelium on the left side.

Contributed by Khalid Amin, M.D.

Liver & intrahepatic bile ducts > Hepatocellular adenoma

HNF1A mutated hepatocellular adenoma: low power view showing well defined border between the lesion (right) and background liver (left).

Contributed by Monica Abdelmalak, M.D.

30 June 2021: Pathology Images of the Week

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

Muscle & peripheral nerve nontumor > Antisynthetase syndrome associated myositis

57 year old man with positive Jo1 antibody and interstitial lung disease. H&E shows necrotic fibers and myophagocytosis predominantly involving perifascicular fibers. The perimyisial connective tissue appears edematous and fragmented.

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

Ovary > Clear cell carcinoma

Clear cell carcinoma with a predominant tubulocystic growth pattern.

Contributed by Gulisa Turashvili, M.D., Ph.D.

Prostate gland & seminal vesicles > Sarcomatoid carcinoma

A monophasic sarcomatoid carcinoma shows only a spindle cell component with mesenchymal appearance, without admixed carcinoma. Extensive sampling and history of prostatic adenocarcinoma, preferably with immunohistochemical (keratins, rarely PSA or other prostatic markers) evidence of epithelial differentiation, helps establish the diagnosis.

Contributed by Steven Christopher Smith, M.D., Ph.D.

Stains & molecular markers > PRAME

Positive nuclear staining for PRAME in seminiferous tubules.

Contributed by Cecilia Lezcano, M.D.

23 June 2021: Pathology Images of the Week

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

Informatics, digital & computational pathology > Data representation and communication standards

The PNG image has been encoded into JPG using a high quality setting (approximately 329 KB).

Contributed by Chris Williams, M.D.

Uterus > Low grade endometrial stromal sarcoma

Deceptively well circumscribed tumor with a tan-yellow soft cut surface; microscopic evaluation revealed myometrial and lymphovascular invasion.

Contributed by Elizabeth Kertowidjojo, M.D., Ph.D., M.P.H.

Colon > Ulcerative colitis

Active chronic colitis with cryptitis is noted.

Contributed by Rachel Horton, D.O. and Catherine E. Hagen, M.D.

Liver & intrahepatic bile ducts > Histology

Periodic acid-Schiff with diastase (PASD) highlights the basement membrane of bile ducts. It also stains alpha-1 antitrypsin globules in hepatocytes in the setting of alpha-1 antitrypsin deficiency. The lack of globules in this image is a normal finding.

Contributed by Kimberley J. Evason, M.D., Ph.D.

Ovary > Yolk sac tumor

Schiller-Duval body

Contributed by Sharon Song, M.D.

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.