23 February 2021: Image Quiz #50

Authors: Zachary Dong, M.D.Kimberley J. Evason, M.D., Ph.D.

Which of the following is true about this liver lesion?

Select an answer:

A. It usually communicates with intrahepatic bile ducts

B. The epithelium is usually CK20+

C. The stroma is usually ER / PR-

D. There is a strong female predominance

E. These lesions are most commonly multifocal

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9 February 2021: Image Quiz #49

Authors: Jennifer Pors, M.D.Lynn Hoang, M.D.

Which immunohistochemical staining profile would you expect in the cervical neoplasm depicted in this image?

Select an answer:

A. PAX8-, ER-, GATA3+, AMACR+

B. PAX8+, ER-, GATA3+, napsin A-

C. PAX8+, ER+, GATA3-, napsin A-

D. PAX8+, ER-, napsin A+, AMACR+

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30 December 2020: Images of the Week

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

MDM2

Corresponding MDM2 IHC in an atypical lipomatous tumor / well differentiated liposarcoma highlighting scattered nuclei within fibrous septa in a strong, diffuse pattern.

Contributed by Jennifer Yoest, M.D. (source: University of Michigan Virtual Slide Box)

Papillary thyroid carcinoma > Diffuse sclerosing

DSV PTC shows prominent and extensive intratumoral interstitial sclerotic stroma. Malignant cells grow in an irregular infiltrative pattern and show typical nuclear features of PTC.

Contributed by Livia Florianova, M.D., M.Sc. and Marc Pusztaszeri, M.D.

Chondromyxoid fibroma

The cellular population within the nodules shows spectrum of differentiation, comprising of stellate to spindle mesenchymal cells in a myxoid background at one end, as seen in this example, to well developed hyaline cartilaginous differentiation on the other end.

Contributed by Nasir Ud Din, M.B.B.S.

Placenta accreta, increta and percreta

A chorionic villous implants directly onto myometrial fibers with no intervening decidua.

Contributed by Fabiola Medeiros, M.D.

Fibroepithelial (stromal) polyp

Fibroepithelial polyp excision showing polypoid lesion with stromal component extending up to epithelium.

Contributed by Albert Alhatem, M.D. and Debra S. Heller, 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.


29 December 2020: Image Quiz #46

Authors: Aysha Mubeen, M.D.Arun Gopinath, M.D.

The grossing protocol for examination of the fallopian tube to identify the diagnosis in the photomicrograph should:

Select an answer:

A. Ensure complete evaluation of the fallopian tube in all cases

B. Increase detection of precursor lesions in at risk women

C. Require multistep levels in at risk women

D. Require tangential sectioning of the infundibulum and fimbrial segment to allow maximal exposure

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16 December 2020: Micro Images of the Week

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

Adenosis

Expanded terminal duct lobular unit and adjacent (upper left) normal size terminal duct lobular unit (H&E, 4X).

Contributed by Julie M. Jorns, M.D.

Congenital mesoblastic nephroma

Tumor composed of intersecting fascicles of spindle cells.

Contributed by Ellen D’Hooghe, M.D. and Gordan M. Vujanic, M.D., Ph.D.

Large B cell lymphomas: ALK+ LBCL

ALK positive large B cell lymphoma with ALK positivity (bone marrow, IHC, 200x).

Contributed by Marie Therese Manipadam, M.B.B.S., M.D.

Molecular aspects of pancreatic cancer

Site: pancreatic head. Procedure: Whipple resection. Diagnosis: medullary pancreatic ductal adenocarcinoma. Histologic finding: neoplastic cells with syncytial growth and without gland formation (hematoxylin eosin, original magnification 10x). Molecular findings: microsatellite instability is very common in the case of medullary histology.

Contributed by Claudio Luchini, M.D., Ph.D.

Chronic sialadenitis / sialolithiasis

40 year old man with submandibular pain; chronic inflammation with acinar atrophy and fibrosis (10x).

Contributed by James S. Lewis, 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.


15 December 2020: Image Quiz #45

This is a liver biopsy from a patient who has a pancreatic mass. What is your diagnosis?

Answer – Metastatic pancreatic ductal adenocarcinoma. 

Comment – This pancreatic ductal adenocarcinoma has spread to the liver and “colonized” a bile duct in a portal tract. A separate bile duct in the same postal tract is unaffected. The malignant nuclei show loss of SMAD4/DPC4, a useful finding for this tumor (Am J Surg Pathol 2000;156:37).

This case was provided by Dr. Elizabeth Montgomery, Professor of Pathology and Vice Chair of Anatomic Pathology at the University of Miami and Editor-in-Chief of the Pathology Survival Guides at Innovative Pathology Press / Innovative Science.

The Survival Guide to Liver Pathology will be released soon! Order your copy at https://www.innovativesciencepress.com/product-page/survival-guide-to-liver-pathology.

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9 December 2020: Images of the Week

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

Adenomyoepithelial adenosis

Haphazardly arranged glands with bland epithelium and prominent myoepithelium with clear cytoplasm (H&E, 20x).

Contributed by Julie M. Jorns, M.D.

CD70

Immunohistochemical double staining demonstrating expression of CD34 (brown) by myeloid blasts and CD70 (red) by interstitial immune cells.

Contributed by Christian Schürch, M.D., Ph.D.

Indeterminate cell histiocytosis

Skin biopsy showing histiocytoid cells with eosinophilic cytoplasm and grooved, reniform nuclei in the dermis in indeterminate cell histiocytosis, 400x.

Contributed by Ryanne A. Brown, M.D., M.B.A.

Atypical carcinoid

Pulmonary atypical carcinoid tumor showing salt and pepper chromatin with inconspicuous nucleoli (400x).

Contributed by Philippe Joubert, M.D., Ph.D.

Buschke-Löwenstein tumor

Low magnification view of resection sample shows arborizing papillary architecture and maturing squamous surface epithelium.

Contributed by Lewis A. Hassell, M.D. (source: Juan Rosai Slide Collection)

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.


1 December 2020: Image Quiz #44

Authors: Gahie Nam, M.D.Kamaljeet Singh, M.D.

A 59 year old woman had a 1.0 cm spiculated breast mass, represented below. Tumor cells express GCDFP-15, mammaglobin, S100 and calretinin. Hormone receptors (ER / PR / HER2) are triple negative. Myoepithelial markers (p63 and SMMHC) are also negative. Other negative markers include TTF1 and thyroglobulin. What is the most common molecular alteration seen in these tumors?

Select an answer:

A. BRAF mutation

B. CDH1 mutation

C. IDH2 R172 hotspot mutations

D. RET mutation

E. TET2 truncating mutation

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17 November 2020: Image Quiz #43

Authors: V. Claire Vaughan, M.D.Joshua Wisell, M.D.

An elderly man presents to the dermatology clinic with a flesh colored papule over the lateral cheek without arborizing vessels or crust. Biopsy is shown. What is the most likely diagnosis?

Select an answer:

A. Basal cell carcinoma

B. Basaloid follicular hamartoma

C. Syringoma

D. Trichoblastoma

E. Spiradenoma

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3 November 2020: Image Quiz #42

Authors: Fenghua Peng, M.D., Ph.D.Jonathan E. Zuckerman, M.D., Ph.D.

Which of the following is true about IgG4 related disease in the kidney?

Select an answer:

A. Always involves the kidney diffusely

B. Dense lymphoplasmacytic cell infiltration is common

C. Interstitial inflammation and fibrosis are usually absent

D. Most patients tend to be young women

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