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.

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.

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.

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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.

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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.

10 March 2021: Images of the Week

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

Liver & intrahepatic bile ducts > Chronic antibody mediated rejection

H&E stained section at 20x demonstrating a predominantly mononuclear portal inflammatory infiltrate with spillage into adjacent hepatic parenchyma.

Contributed by Mohamed El Hag, M.D., M.S.

Liver & intrahepatic bile ducts > Hepatoblastoma

Hepatoblastoma, SCUD pattern, with siderophages (secondary to treatment) (H&E 200x).

Contributed by Rui Caetano Oliveira, M.D. and Maria Augusta Cipriano, M.D.

Lung > Minimally invasive 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.

Ovary > Serous tumors > Serous borderline tumor

Inked cyst wall lined by exuberant solid growth of papillary grape-like excrescences.

Contributed by Aarti Sharma, M.D. and Ricardo R. Lastra, M.D.

Placenta > Complete hydatidiform mole

Haphazard circumferential proliferation of cytotrophoblasts and syncytiotrophoblasts is seen around a club shaped villus in this image of a complete mole. Some of the nuclei show considerable atypia and mitoses.

Contributed by Rachelle Mendoza, M.D. and Raavi Gupta, M.D.

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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 60 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.

3 March 2021: Images of the Week

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

Cervix > HPV related adenocarcinoma (usual type and variants)

Invasive adenocarcinoma, pattern B (H&E stain). Early destructive invasion, in an otherwise well differentiated (pattern A) neoplasm is seen as small irregular glands with prominent inflammation and stromal desmoplasia.

Contributed by Carlos Parra-Herran, M.D.

Stains & molecular markers > HER2 colon

Score 3+, HER2 IHC: the tumor cells of this colorectal adenocarcinoma show strong circumferential membrane staining (200x).

Contributed by Roula Katerji, M.D. and Aaron R. Huber, D.O.

Stains & molecular markers > Pan-TRK (EPR17341) [NTRK]

Infantile fibrosarcoma spectrum of tumors – neonate at birth with a lower thigh mass harboring a TPM3-NTRK1 fusion: panTRK antibody with cytoplasmic expression (400x).

Contributed by Jessica L. Davis, M.D.

Liver & intrahepatic bile ducts > Hepatocellular carcinoma overview

Hepatectomy for hepatocellular carcinoma demonstrating large cytoplasmic hyaline eosinophilic inclusions and trabecular architecture (400x).

Contributed by Irene Y. Chen, M.D.

Small intestine & ampulla > Adenocarcinoma-small intestine

Diagnostic low magnification frozen section image showing complex glandular architecture and desmoplastic stromal reaction (H&E, 40x).

Contributed by Krutika S. Patel, M.B.B.S., M.D. and Annika L. Windon, M.D.

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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 60 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.

16 February 2021: Images of the Week

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

Bone marrow neoplastic > AML with t(8;21)(q22;q22)

Scattered blasts with prominent eosinophilic granules and rare Auer rods (leftmost blast).

Contributed by Sean Gu, M.D., Ph.D. and Alexa J. Siddon, M.D.

Kidney tumor > Adult renal cell carcinoma – common > Chromophobe eosinophilic variant

Chromophobe renal cell carcinoma eosinophilic variant, demonstrating diffuse marked perinuclear clearing / halos.

Contributed by Timothy Isaac Miller, M.D., M.A. and Maria Tretiakova, M.D., Ph.D.

Liver & intrahepatic bile ducts > Glycogenic hepatopathy

Pale and enlarged hepatocytes in a mosaic pattern with prominent cytoplasmic membranes and scattered background macrovesicular steatosis (200x).

Contributed by Raul S. Gonzalez, M.D.

Ovary > Endometrioid carcinoma

Back to back endometrioid glands; no solid component is seen.

Contributed by Ozlen Saglam, M.D.

Prostate gland & seminal vesicles > Low grade PIN

Atypical acinar cells with few scattered nucleoli growing in a tufted architecture (40x).

Contributed by Nicholas P. Reder, M.D., M.P.H.

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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 60 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.

2 December 2020: Images of the Week

Here are just a few of this week’s new images from our free, online textbook:

Low grade intraosseous (central) osteosarcoma

Cellular fascicles of spindle cells with mild nuclear atypia in a fibrosclerotic stroma.

Contributed by Borislav A. Alexiev, M.D.

AML with inv(3)(q21.3;q26.2) or t(3;3)(q21.3;q26.2)

Bone marrow aspirate showing a hypolobated megakaryocyte, increased blasts and a pseudo-Pelger-Hüet neutrophil.

Contributed by Alexa J. Siddon, M.D.

Telecytology

Snapshot of dynamic microscopy from the pathologist end (10x objective), showing annotations and the control buttons.

Contributed by Jason A. Thomas, C.T. and Sigfred Lajara, M.D.

Liver & intrahepatic bile ducts → Viral hepatitis → COVID-19

Occasional cases (15%) have sinusoidal microthrombi (600x).

Contributed by Stephen M. Lagana, 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 61 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.