15 February 2022: Image Quiz #76

Authors: Josephine K. Dermawan, M.D., Ph.D.Karen Fritchie, M.D.

A 54 year old woman presents with a 9.6 cm, well circumscribed, firm mass in the deep soft tissue of the thigh. Histologic sections show ovoid to spindled cells arranged haphazardly around prominent, thin walled, hyalinized, dilated, staghorn type vasculature (see image below). Which of the following is the most sensitive and specific immunohistochemical marker for the diagnosis of this tumor?

Select an answer:

A. Actin

B. BCL2

C. CD34

D. Cytokeratin CAM 5.2

E. STAT6

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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.

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.

20 April 2021: Image Quiz #54

Author: Borislav A. Alexiev, M.D.

Which of the following is true about composite hemangioendothelioma?

Select an answer:

A. Harbors WWTR1-CAMTA1 fusions

B. Harbors ZFP36-FOSB fusions

C. HHV8+

D. Typically does not recur after excision

E. Distinguishing from other vascular neoplasms largely lies in finding different histologic vascular patterns within 1 lesion

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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.

3 February 2021: Images of the Week

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

Soft tissue > Sclerosing epithelioid fibrosarcoma

Sclerosing epithelioid fibrosarcoma with EWSR1-CREB3L1 fusion. Small, round to ovoid epithelioid cells with sparse, often clear cytoplasm and round to oval nuclei.

Contributed by Borislav A. Alexiev, M.D.

Stains > HPV (Human papillomavirus)

p16 diffuse and strong nuclear and cytoplasmic staining in HSIL.

Contributed by Ana Félix, M.D., Ph.D.

Stomach > Carcinoma-general

Gastric tumor with linitis plastica pattern: diffuse rugal flattening and thickening of the gastric wall. Note the absence of a well defined tumor mass.

Contributed by Clara Alfaro, M.D., Ph.D.

Vulva, vagina & female urethra > Condyloma

Condyloma acuminatum of the vulva with acanthosis, papillomatosis and basal fusion of broad papillae. There are no significant viral specific changes of the epithelium.

Contributed by Matthias Choschzick, 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.

27 January 2021: Images of the Week

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

Microglandular hyperplasia

High power view showing columnar epithelial cells with subnuclear and supranuclear vacuoles, bland nuclei and mucinous cytoplasm, associated with reserve cell hyperplasia; luminal neutrophils in some glands.

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

Epithelioid hemangioendothelioma

Tumor is comprised of cords, strands and small nests of large endothelial cells with abundant eosinophilic cytoplasm embedded in a myxohyaline stroma.

Contributed by Iva Brčić, M.D., Ph.D. and Bernadette Liegl-Atzwanger, M.D.

Sertoli cell tumor, NOS

Testicular Sertoli cell tumor, NOS (H&E), low magnification, back to back cords of bland, clear cells with abundant cytoplasm.

Contributed by Thomas Ulbright, M.D.

Coombs test / DAT

The results of a patient’s direct antiglobulin (DAT) / Coombs test.

Contributed by Thomas J. Gniadek, 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 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.

14 January 2021: Images of the Week

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

Adenomyoepithelioma

Higher power image of the breast lumpectomy specimen demonstrates the dual cell population of myoepithelial cells surrounding epithelial glands with luminal secretions. Diagnosis: adenomyoepithelioma.

Contributed by Hannah Y. Wen, M.D., Ph.D.

Liver hemangioma

Well circumscribed and nonencapsulated large mass with a red-brown color, focal honeycombed appearance, sponge-like consistency and foci of fibrosis.

Contributed by Lizhi Zhang, M.D.

Multicystic mesothelioma

Multicystic mesothelioma (top) involving the omentum (bottom). The lesion comprises multiple variably sized, predominantly collapsed cysts. It involves the omental surface without infiltration of underlying fat (H&E, whole slide).

Contributed by David B. Chapel, M.D.

Erythema elevatum diutinum

In the superficial dermis, there are dilated thin walled vessels and prominent fibrosis overlying a polymorphous inflammatory infiltrate in this established lesion (H&E, 40x).

Contributed by Kiran Motaparthi, M.D.

Ossifying fibromyxoid tumor

Ossifying fibromyxoid tumor. Nodular growth of uniform, round or ovoid cells with bland nuclei.

Contributed by Borislav A. Alexiev, 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.


16 November 2020: Images of the Week

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

Angiomyolipoma

Hepatic angiomyolipoma showing characteristic mixture of smooth muscle cells, adipocytes and blood vessels (upper right).

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

Myoepithelioma / myoepithelial carcinoma / mixed tumor

Myoepithelioma of soft tissue. Proliferation of epithelioid cells with clear cytoplasm.

Written by Borislav A. Alexiev, M.D.William B. Laskin, M.D.

Carcinosarcoma (MMMT)

A high power figure of a biphasic neoplasm composed of highly malignant epithelioid and spindle cells and prominent chondroid-like matrix.

Written by Joana Ferreira, M.D.Ana Félix, M.D., Ph.D.

Cellular angiofibroma

Short fascicles of bland spindle cells admixed with small hyalinized vessels (100x).

Written by David B. Chapel, M.D.Jennifer Bennett, 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.


6 October 2020: Image Quiz #40

Authors: Michella Whisman, M.D.Jerad M. Gardner, M.D.

The image below comes from a finger mass of a 45 year old woman. Grossly, the lesion was well circumscribed and bosselated. Which of the following features must be identified to the make the diagnosis?

Select an answer:

A. Foamy macrophages

B. Hemosiderin laden macrophages

C. Histiocytoid mononuclear cells

D. Inflammatory cells

E. Multinucleated giant cells

To sign up for our biweekly image quiz newsletters and more, visit pathologyoutlines.com/subscribe.html.