28 June 2022: Image Quiz #85

Authors: Jutta Huvila, M.D., Ph.D.C. Blake Gilks, M.D.

Which of the following is true about benign Brenner tumors of the ovary?

Select an answer:

A. Composed of both epithelium and fibromatous stroma

B. Papillary architecture

C. Typically > 10 cm

D. Usually present with abdominal pain

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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.

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.

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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.

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.

7 April 2021: Images of the Week

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

Cervix > HSIL / CIN II / CIN III

At high magnification, HSIL / CIN III lacks maturation (400x).

Contributed by Khaled J. Alkhateeb, M.B.B.S.

Ovary > Fibroma

Ovarian fibroma: the cut surface reveals a dense white mass within the ovary (left); outer surface of the fibroma is smooth and lightly vascularized (right).

Contributed by Rex Bentley, M.D.

Testis & epididymis > Adult granulosa cell

Low power view of numerous small uniform spaces (microfollicles) with hyalinized basement membrane material (Call-Exner bodies).

Contributed by Kristine M. Cornejo, M.D.

Microbiology & parasitology > Zygomycetes

Evaluation of fungal forms. H&E stained FFPE tissue showing broad pauciseptate ribbon-like hyphae in necrotic sinonasal tissue.

Contributed by Sixto M. Leal, Jr., M.D., Ph.D.

Skin nonmelanocytic tumor > Syringoma

Histologic sections showing cysts, nests and cords in a paisley or tadpole shaped pattern. No cytologic atypia or mitotic figures are seen (H&E, original magnification 100x).

Contributed by Aadil Ahmed, M.D. and Sara C. Shalin, 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.

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.


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.

17 February 2021: Case of the Month #500

Thanks to Dr. Sakinah A. Thiryayi and Dr. Gulisa Turashvili, Mount Sinai Hospital, Toronto (Canada) for contributing this case and writing the discussion and to Dr. Ricardo R. Lastra, University of Chicago Medical Center, Chicago, Illinois (USA), for reviewing the discussion.

Clinical history:

A 52 year old woman was found to have an ovarian mass on computed tomography imaging and an elevated CA-125 of 234 U/mL (reference range: less than 46 U/mL). The mass was excised.

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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