Histopath images thread

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yaah

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Always fun to post pics!

First one: Classic lesion, don't see it much because it is often easily diagnosed on radiology. Buzzword: "Popcorn calcification." This was a solitary lung lesion in someone with a history of renal cell carcinoma. Answer is below.

chondlow.jpg


chondhigh.jpg




Answer: Pulmonary hamartoma! It's classic - it has the cartilage, the fat, and the bronchial epithelium lining the thin spaces.

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hey i saw one of those on my path month :thumbup:

i forgot it was. but since it's pretty classic --> conclusion = Andy = *******
 
#2: Multiple lung lesions in a patient with a "Sinus cancer"

This one was around the bronchus and looked grossly like it could be a primary cancer of the lung (autopsy case).

acclow.jpg


Higher power:

acchigh.jpg


This is an interesting tumor - easily recognized because it's pretty distinctive (although some others can mimic it). Oddly, it doesn't metastasize to the lungs very frequently. Adenoid Cystic Carcinoma. I just think it's neat how it's invading the bronchus like that. :thumbup:
 
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Lung always provides interesting path

Anyone know what this is?
lunglesion10x.jpg



And this is always a pretty tumor
0eb96ab2.jpg
 
Large liver mass in a 1 year old:

Low power:
473856b3.jpg


Higher power:
d4b3587b.jpg



Answer (highlight the area to the right to see the answer): Mesenchymal Hamartoma
 
It was actually a cool aortic dissection case because the dissection went from the aorta proximally and caused tamponade and extended into the lungs, and distally all the way down to the iliacs, and had occluded the splenic, SMA, and one of the renals.
 
It's actually embolization particles from an interventional radiology procedure. It is from a lung that was hemorrhaging, and was embolized in IR. Didn't work, so they did a lobectomy.

2nd one is a bronchoalveolar CA.
 
yaah said:
It was actually a cool aortic dissection case because the dissection went from the aorta proximally and caused tamponade and extended into the lungs, and distally all the way down to the iliacs, and had occluded the splenic, SMA, and one of the renals.

Did the guy live? :laugh:

Edit: Hamartomas are pretty sweet.
 
Parts of that slide from the lobectomy look 3-D.
 
Yes - during the autopsy he sat bolt upright and said "I'm not dead yet!" but a few seconds with the Stryker saw and the diener had him under control. ;)
 
Old images that I posted of the gouty tophus disappeared because they were on a bad image hosting site...here they are again


Polarized gout - monkeying with the polarizer a bit:

e3d17f83.jpg


More normal polarized appearance:

gouty.jpg



Other versions are on my other computer, will post another day.
 
Beautiful pictures, yaah! Thanks for posting them! :thumbup:

...and nice job with the RISE--I must say I'm not surprised.
 
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Beautiful!

I can't wait to get old.
 
Well, similar to my med school experience I guess. One problem I had was that I would often think of the right answer, yet I wouldn't say anything. Then when the attending said the answer I would curse to myself. It's odd, because I am somewhat talkative, and would offer answers on other occasions. I just noticed that often when I had a first thought in a random situation I held my tongue.
 
I was looking till my eyes were sore for these today - I didn't find any.

211028093.jpg
a morula of Ehrlichia

Highlight to the right of the image for the answer.
 
yaah - thanks for the cases. I think it would be great if people would put up cool & interesting cases!
 
yaah said:
2 Renal Tumors:

1)
renal10x.jpg

Isn't that a papillary renal cell carcinoma? I only know because we had one for surg path unknowns. There's supposed to be three patterns: pure papillary, trabecular, and solid. And with the pure papillary you can see foamy histiocytes taking up the fibrovascular core. Though it kind of looks trabecular too.
 
A lot of times you see mixed features. It is a papillary RCC (type I). The foamy histiocytes are pretty classic for it - the cholesterol clefts are too, although less common.

Appendiceal carcinoid invading the cecum

tumorandcecum.jpg
 
yaah said:

and what's the site of this? also renal? what is it?


hey everybody...this thread started by yaah is truly sweet. Let's keep it up, and try'n put the SITE, with the answer in WHITE FONT below [ingenious idea yaah!!! you are a giant pimp].
 
Yes - the other renal cell is a clear cell - it has some cyst formation. Furman grade 2/4, although on this view you could probably argue 1/4.

The other is CMV gastritis. See the CMV cells?
 
That was curretted but not seen? Strange. One of those cases where they neglect to mention something in the clinical history of the requisition.

Oh, by the way, the patient has a history of previously resected cancer, and exam revealed a large mass.
 
yaah said:
That was curretted but not seen? Strange. One of those cases where they neglect to mention something in the clinical history of the requisition.

Oh, by the way, the patient has a history of previously resected cancer, and exam revealed a large mass.
oh they saw it alright! but yeah, sometimes the histories given on the form that accompanies the specimen is pretty poor :laugh: anyways, i can imagine that the vag doc saw a portion of some sort of exophytic mass coming out of the os and thought, "I'm gonna have a field day with this. Hey, f*ck the curettage brush, go get me a spoon!"

that and another case...i plan to read up on the history in the medical record tomorrow morning before signout...i mean, it's not going to change the diagnosis but i'm doing it for curiosity's sake. it's always interesting to read how these patients presented and what the clinicians knew prior to proceeding with a particular biopsy procedure.
 
this is from a vaginal biopsy

vagina1.jpg


here are two close-up fields:

in one field, you see this.
vagina3.jpg


in a nearby field, you see this.
vagina4.jpg
 
i've also seen many cases of serous papillary adenocarcinoma as well but those cases involve multiple specimens that all contain cancer. i figure everyone's seen one of those so i elected not to put it up. but if people want, i can dig out the case and take some snapshots just for sh*ts and giggles.

anyways, more to come depending on if i see anything else that seems cool. of course, i'm on my gyn biopsy week so the majority of my specimens are benign cervices :laugh:

next week, i start the "BRING THE PAIN" weeks so i think i'll be starting to amass a variety of surg path case photos.

taking pictures is kinda fun. it's like an art. maybe i should've been a photographer. NOT!
 
Having not seen much vag path yet, I am at a bit of a loss to explain those slides. Not sure what gives you such a dense inflammatory infiltrate of so many cell types there. Syphillis? :laugh:

That's also a pretty big biopsy. :eek:
 
SLUsagar said:
unlike yourself senor ANDY, i truly am a proud ******...
what's the Dx on your pics???
I feel like a ****** today. Missed a focus of obvious LSIL when I previewed one of my slides last night.

You cought the LSIL on the other slide but you missed this???.
Quite embarrassing. I am a ******. And I'm damn frickin' proud of it! Dehhhh.

OK so the diagnosis on the first slide (beta-HCG above 200000)...complete hydatidiform mole. We saw big hydropic villi with cisterns and trophoblastic hyperplasia and atypical implantation sites. No fetal tissue identified microscopically (but in many products of conception slides, you don't see this) but not seeing fetal tissue on the slide in question further bolsters the diagnosis of complete mole.

The second slide (previewed last night and in the process of being signed out) most likely represents an endometrial carcinoma (which is supported by the fact that she has a history of it! She gonna get her uterus taken out.) However, I saw a case where a papillary serous adenocarcinoma originating in an ovary was metastatic to the endometrium (usually, based on my limited experience, I'm used to seeing implants of metastatic papillary serous adenocarcinoma showing up on the serosal surface of the uterus, N=3). That case presented somewhat similarly to this one with a few differences that are outside the scope of this post. So just by looking at the slide, one could make a case for papillary serous. However, looking at the specimen in high power, the cancer looks more endometrioid. We're doing a p53 anyway to shed more light on the matter. We'll get the impox slide tomorrow and we should be able to sign it out soon thereafter.

The third slide was sparked much confusion when I previewed it last night. Showed it to a couple of other residents and fellows. Could've been infectious given all that plasmacytic, eosinophilic, neutrophilic, yada yada yada infiltrate. However, at signout, it was called granulation tissue. Looked at the history this morning and the patient is status post hysterectomy. This specimen was taken from the apex of the vagina. Apparently, after these surgeries, patients can get these "cherry red" spots at the surgical scar. But this was a surprise to me nonetheless. But at signout it made sense as the attending was explaining it. If you look at the superficial aspect of the lesion, it does look like granulation tissue...and you can still get this kind of infiltrate. After all the mental masturbation that went on last night, the diagnosis is kind of a letdown. Still, a diagnosis has been reached and the case is signed out. Sayonara!
 
AndyMilonakis said:
beta-HCG was over 200,000 on this puppy.
200000.jpg

So that's what moles look like. I screen through those POCs like they're nothing.
 
man, i just saw a carcinoid case and was gonna put it up. well, lo and behold, what do i see, the last post in this thread deals with carcinoid.

ok, well, there's that case going out the sh*tter.

here's another cancer case. also involving the appendix like your carcinoid case. btw, this tumor was part of a bigger colon resection too. i don't recall exactly where the primary is (came from an outside hospital and we don't have history) but it's likely to be somewhere from the GI tract as it was Ck20 and CDX2 positive.

enjoy!

AssCancer.jpg


And here are the Ck20 and CDX2 stains, in respective order.

CK20.jpg

CDX2.jpg
 
This chick has undergone multiple debulking surgeries. She is on TPN.

stfu1.jpg

stfu2.jpg
 
deschutes said:
Um, need higher power.

stfu1 & 2?? :laugh:
Yes, "stfu" was on my mind when I took those pictures. Another resident and I were talking about how some people don't know when to STFU. When I take these pics, I save the file as the medical record number. But of course, I change the names to random names such as to not suggest the diagnosis when I post the pics here :)

I was too lazy to take higher power pictures :p

The stfu slides were pic shots of dedifferentiated liposarcoma. You can have some areas of well-differentiated liposarc where you have adipocytes (some of which can be atypical adipocytes or even lipoblasts) with intervening areas of fibrous tissue which contain atypical cells with hyperchromatic and pleiomorphic nuclei. But then you have a transition to less fatty areas (second slide) where you have increased cellularity with atypical cells which adopt a "storiform" arrangement. These features can be appreciated at lower power.

Speaking of lower vs. higher power...someone was joking around by saying, "low power there [pointing to scope], high power here [pointing to one's brain]...high power there [pointing to scope], low power here [pointing to one's brain]."

I point to your skull and think, "low power" :p

I jest, of course. You can see bizarre mitotic figures better under high power. But I can see them under low power too :p
 
So many smileys. It's the beer talking :rolleyes: ;)

AndyMilonakis said:
Yes, "stfu" was on my mind when I took those pictures. Another resident and I were talking about how some people don't know when to STFU.
I agree. I've recently come to the conclusion that this so-called being "easy to work with" is sometimes simply a matter of knowing when to shut up.

AndyMilonakis said:
When I take these pics, I save the file as the medical record number. But of course, I change the names to random names such as to not suggest the diagnosis when I post the pics here :)
Your patient's MRN is suggestive of the diagnosis? :eek: ;)

AndyMilonakis said:
The stfu slides were pic shots of dedifferentiated liposarcoma.
I remember now. Those things - I mean, "entities", can get rather large. Which of course you so kindly pointed out in the history :)

What is the significance of the TPN?

AndyMilonakis said:
I point to your skull and think, "low power" :p
I know. :( I console myself with the thought that I don't run on beer.

:p
 
deschutes said:
Your patient's MRN is suggestive of the diagnosis? :eek: ;)
It's a potential HIPAA issue (maybe I'm making a big deal out of it but I don't wanna f*ck myself over here).
What is the significance of the TPN?
She has no bowel left. She had most of it removed in previous debulking procedures. She was diagnosed with this disease 20 years ago.
I know. :( I console myself with the thought that I don't run on beer.
Clever.
 
AndyMilonakis said:
You have to know these kind of things when you're a king, you know. (quote?)

Q: And how do you know that he's a king?

A: He hasn't got **** all over him.


Probably posted this before - this in comparison is a more well differentiated liposarcoma.

lipohigh.jpg
 
yaah said:
Probably posted this before - this in comparison is a more well differentiated liposarcoma.

lipohigh.jpg
Sup yaah,

Is that myxoid type by any chance? I think I read that liposarcs have 3 categories and myxoid may be one of them (not sure if I'm getting confused with another tumor entity).
 
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