12 July 2022: Image Quiz #86

Authors: Simona De Michele, M.D.Helen E. Remotti, M.D.

When evaluating the pulmonary neoplasm shown in the image, which immunohistochemical stain is more specific than CDX2 for ruling in a colorectal metastasis?

Select an answer:

A. CK7

B. CK20

C. Napsin A

D. SATB2

E. TTF1

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

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.

To subscribe to our newsletters and receive new images in your inbox biweekly, visit pathologyoutlines.com/subscribe.html.

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.

28 May 2021: Weekly Roundup #48


This is what’s new on PathologyOutlines.com:

1. New Editorial Board Member for GI Pathology

Dr. Monika Vyas has been appointed to the Editorial Board for GI pathology. Dr. Vyas completed her early pathology training at the Tata Memorial Hospital in Mumbai, India, followed by an AP/CP residency at the Yale New Haven Hospital, New Haven, CT.  She subsequently did an Oncologic Surgical Pathology fellowship and a Gastrointestinal / Pancreatobiliary Pathology fellowship at the Memorial Sloan Kettering Cancer Center in New York, NY. She joined the faculty at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, MA in 2019.

2. Jobs Records

We had a record 114 jobs posted in April. Our previous record was 111 in October 2019. In addition, as of 27 May 2021, we have 506 jobs posted, the highest number in our history.

3. Chapter Updates

We recently merged the CD markers chapter into the Stains chapter. We also created a Molecular markers chapter and a Cytopathology chapter. Because we are moving some topics to other chapters, we will soon be removing the Methods chapter.

4. Author Collage

Thank you to the great authors who are contributing to our free online textbook. The collage on our homepage and 2020 authors page lists those who were particularly productive in 2020.

5. Books Posted in May

The following books were posted to our books database in May 2021:

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.

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 March 2021: Images of the Week

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

Breast > Filariasis

Classic “double barrel” uterus of the adult female worm (Wuchereria bancrofti) with eggs and developing larvae (microfilariae) in a lymph node (H&E, 10x).

Contributed by Bobbi Pritt, M.D.

Stains & molecular markers > Carbonic anhydrase IX

Diffuse circumferential membranous staining in clear cell RCC.

Contributed by Nick Baniak, M.D.

Stomach > MALT lymphoma

Infiltration and distortion of epithelial structures by aggregates of (usually 3 or more) neoplastic lymphoid cells.

Contributed by Kwun Wah Wen, M.D., Ph.D.

Testis & epididymis > Sex cord-stromal tumors > Leydig cell

Leydig cell tumor with sheets of polygonal cells with eosinophilic cytoplasm (H&E stain; 10x magnification).

Contributed by Manju Aron, M.D.

Autopsy & forensics > Therapy related deaths

Autopsy image of a percutaneous biliary catheter in the portal vein. The biliary drain placement was performed to relieve a biliary stricture but the catheter was placed in the portal vein adjacent to the targeted bile duct resulting in hemoperitoneum. The end of the catheter was cut during removal of the liver as this was an unexpected finding at autopsy.

Contributed by Mark A. Giffen, Jr., D.O.


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.

20 January 2021: Images of the Week

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

Acute mastitis / abscess

Core needle biopsy from a 28 year old lactating woman. A dense inflammatory infiltrate is shown on the left, obscuring underlying breast parenchyma.

Contributed by Kristen E. Muller, D.O.

Prostate specific antigen (PSA)

PSA is focally positive, which is common in more poorly differentiated prostatic adenocarcinoma. Lung adenocarcinoma will not be positive for PSA, so this confirms metastatic prostatic adenocarcinoma. Of note, this patient had a clinical history of a prostatic adenocarcinoma.

Contributed by Heather I-Hsuan Chen-Yost, M.D.

Fibromatosis / fasciitis-like

Papillary thyroid carcinoma with fibromatosis / fasciitis-like stroma: myofibroblastic proliferation within collagenous stromal tissue.

Contributed by Ayana Suzuki, C.T.

Gunshot wounds

Soot deposition, searing of the skin and contusion surrounding the central defect.

Contributed by Lorenzo Gitto, M.D. and Robert Stoppacher, 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.