15 November 2022: Image Quiz #95

Authors: Samuel Bidot, M.D.Saja Asakrah, M.D., Ph.D.

This specimen is a touch imprint obtained from an axillary lymph node of a 35 year old white man with HIV. Which of the following viruses is associated with this disease and with what frequency?

Select an answer:

A. Epstein-Barr virus in 30% of cases

B. Epstein-Barr virus in > 95% of cases

C. Human herpesvirus 8 in 50% of cases

D. Human herpesvirus 8 in > 95% of cases

E. Human T cell leukemia virus type 1 in > 95% of cases

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23 September 2022: Case of the Month #519

Thanks to Drs. Mario Marques-Piubelli and Roberto Miranda, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, for contributing this case and discussion and to Dr. Genevieve Crane, Cleveland Clinic, Cleveland, Ohio, USA, for reviewing the discussion.

Clinical history:

A 51 year old man with a medical history of HIV infection who was noncompliant with antiretroviral therapy presented with cough, dyspnea, chest pain, fever and pancytopenia. CT showed pleural and pericardial effusions but no masses. A pleurocentesis was performed.

All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page.

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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.

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.

31 March 2021: Images of the Week

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

Lymphoma & related disorders > Aggressive NK cell leukemia

Trephine bone marrow biopsy showing an interstitial neoplastic infiltrate at high power, with moderate cytoplasm, irregular nuclear contours and prominent nucleoli.

Contributed by Siba El Hussein, M.D. and Joseph Khoury, M.D.

Soft tissue > Myxoinflammatory fibroblastic sarcoma

Low power magnification shows a lobulated soft tissue tumor with mixed fibrous and myxoid areas located within subcutaneous tissue.

Contributed by David Suster, M.D.

Stains & molecular markers > DUX4

CIC-DUX4 fusion tumor (DUX4, 10x), involving soft tissue of flank.

Contributed by Bradford Siegele, M.D., J.D.

Skin nontumor > Atrophic papulosis

Superficial and deep perivascular and periadnexal lymphocytic infiltrate (H&E, 40x).

Contributed by Kiran Motaparthi, M.D.

Bone & joints > Ganglion

Myxoid changes (gray-blue areas) are visible in the ganglion wall on the right. The remaining wall is composed of dense pink collagenous stroma. The lining of the wall does not show epithelial cells.

Contributed by Serenella Serinelli, 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 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.

24 February 2021: Images of the Week

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

Colon > Ischemic colitis

Low power image showing crypt injury, marked crypt dropout, lamina propria hyalinization and vascular congestion.

Contributed by Gagandeep Kaur, M.D. and Monika Vyas, M.D.

Lymphoma & related disorders > Richter syndrome

H&E of Richter syndrome, diffuse large B cell lymphoma type. Diffuse sheets of large, atypical cells with finely dispersed chromatin and prominent nuclei.

Contributed by Shahbaz Khan, M.D.

Skin nontumor > Psoriasis

Higher magnification of subcorneal pustule in pustular psoriasis with elongated and dilated capillaries in the papillary dermis. Punch biopsy from the trunk (40x).

Contributed by Viktoryia Kazlouskaya, M.D., Ph.D.

Skin melanocytic tumor > Desmoplastic melanoma

Pure type desmoplastic melanoma consisting entirely of spindle cells in a fibrous stroma without convention melanoma (100x).

Contributed by Gregory A. Hosler, M.D., Ph.D.

Stains & molecular markers > ATM

ATM immunostaining of rectal adenocarcinoma.

Contributed by Joo-Shik Shin, M.B.B.S., 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 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.

26 January 2021: Image Quiz #48

Authors: Cade Arries, M.D., Elizabeth Courville, M.D.

A 45 year old man with a history of renal transplant presented with lymphadenopathy. A lymph node biopsy was performed. A representative image is shown. The large atypical cells are positive for CD30 and CD15 with dim PAX5 nuclear positivity and dim and variable CD20 expression. CD3 and CD45 are negative. Which of the following is the most appropriate diagnosis?

Select an answer:

A. Classic Hodgkin lymphoma posttransplant lymphoproliferative disorder

B. Monomorphic posttransplant lymphoproliferative disorder (diffuse large B cell lymphoma)

C. Nondestructive posttransplant lymphoproliferative disorder (florid follicular hyperplasia)

D. Polymorphic posttransplant lymphoproliferative disorder

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