Histopath images thread
Started by yaah
Touch prep on a large lymph node
Hodgkin's?
One would think so, yes - especially after seeing the H&E - this is a shot of the frozen section but the real one isn't any different.
But all the large cells are CD20 and 79a positive, mostly cd30 and some cd15. It's actually best classified as DLBCL. 😱
But all the large cells are CD20 and 79a positive, mostly cd30 and some cd15. It's actually best classified as DLBCL. 😱
DLCBL?
Met?
These are all long ways of saying I don't know, if you didn't already know.
[Edit]Rats you beat me to it.
Met?
These are all long ways of saying I don't know, if you didn't already know.
[Edit]Rats you beat me to it.
ok, let's try this and hope it works...
encasing mass of lung, autopsy case...
social: shipyard worker.
another pattern (sarcomatoid), in a liver met..
we then digested a portion of lung, leaving only this lil' guy...
dx: [COLOR=Light Blue]malignant mesothelioma (1st - in lung, 2nd - met to liver, 3rd - ferriginous body)[/COLOR]
encasing mass of lung, autopsy case...
social: shipyard worker.
another pattern (sarcomatoid), in a liver met..
we then digested a portion of lung, leaving only this lil' guy...
dx: [COLOR=Light Blue]malignant mesothelioma (1st - in lung, 2nd - met to liver, 3rd - ferriginous body)[/COLOR]
Interesting case! Was that the presumed Dx pre-mortem? (I don't know anything about imaging mesothelioma)SLUsagar said:
To beary - and any other PGY-1's starting on CP - with all my love 😉
Case #1: "Look Ma, that man's got a boob on his head!"
Case #1: "Look Ma, that man's got a boob on his head!"
Case #3:
Now what are you going to do?
Now what are you going to do?
Case #4: 30-something-year-old woman has these:
I've never seen these outside a textbook - and the answer to your next special stain request is "Negative".
She did have the classic CXR 🙂
I've never seen these outside a textbook - and the answer to your next special stain request is "Negative".
She did have the classic CXR 🙂
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I forgot to add that all five are benign.
Quick glance leads me to believe that #4 is sarcoidosis (non-caseating granulomas).
That is correct. Silver stain for fungus and Fite for AFB were negative.
And yes I have been made aware that the low-power focus for micrographs in Case #2 suck - but you can actually see the salient architectural features. Anyway to help you along: it has pushing margins, minimal atypia, no junctional activity, no epidermal invasion, no peripheral inflammation, no necrosis, no mitotic figures.
Did I mention his BUTT?
And yes I have been made aware that the low-power focus for micrographs in Case #2 suck - but you can actually see the salient architectural features. Anyway to help you along: it has pushing margins, minimal atypia, no junctional activity, no epidermal invasion, no peripheral inflammation, no necrosis, no mitotic figures.
Did I mention his BUTT?
Small Cell on a transbronch bx
Leiomyoma with adenomatoid tumor
CMV in the stomach
Osteoid osteoma with area of osteoblastoma
DLBCL that looks like HL
Parathyroid with an area of clear cell change, mimicking a met or other things
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@Deschutes:
1. What's the site. Looks like a papillary eccrine adenoma
2. Don't know. Solitary mastocytoma vs. nevus lesion.
3. Fungal stains. Cutaneous histoplasmosis gets my vote
4. Sarcoid: classic case.
5. Sertoli cell tumor: 10% display malignant behavior.
1. What's the site. Looks like a papillary eccrine adenoma
2. Don't know. Solitary mastocytoma vs. nevus lesion.
3. Fungal stains. Cutaneous histoplasmosis gets my vote
4. Sarcoid: classic case.
5. Sertoli cell tumor: 10% display malignant behavior.
Number 3 is a classic example of histoplasmosis vs leishmaniasis. Making a diagnosis on H&E is difficult since you will be able to see both organisms with that stain, although typically, leishmania is more evident than histoplasma on H&E. Of course, if you do a grocott or gms, then histoplasma is positive and leishmaina is negative. Books mention leishmania organisms have a kinetoplast and stain positive with giemsa. In the couple of cases that Ive seen, the kinetoplast is not obvious at 40X, and the organisms are visualized better with H&E than with giemsa.
Would also include a mucicarmine or alcian blue stain in the work-up to rule-out the less likely possibility of crypto.
Would also include a mucicarmine or alcian blue stain in the work-up to rule-out the less likely possibility of crypto.
Point noted. I thought of that when I first posted the pix, and then didn't have the time to fix it. It's my 5th month of surg path in a row, need I say more? 😉 I'll try to fix it when I'm on Micro.yaah said:
Answer key:
1) Apocrine cystadenoma. (It was on the scalp - I believe I did mention the head in the original post 🙂 )
2) Cellular blue nevus
3) Cutaneous histoplasmosis (Pt was HIV+)
4) Sarcoid, just for fun
and
5) Gonadal stromal tumour, unclassified, benign.
Thanks DrBloodmoney for the revival!
Bumping for those who don't know about this thread and are interested. I have deleted a lot of the redundant and irrelevant posts from this thread.
Crohn's, right?
Still think so?
No, probably not
bumping this so I can find it later in the week.
Very good cases...just wonder if you or anyone else is willing to donate them to Surg path atlas.
Anyway good cases and good quality of the images..
thanx
Anyway good cases and good quality of the images..
thanx
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And just some trivia: the grannular basophilic material deposited in the vascular wall in pt with small cell lung carcinoma is called: Azzopardi phenomenon. It was described by Azzopardi in 1959 who found it in about 20-30% of these tumors and identifyed it as DNA. The same phenomenon is described with meduloblastomas/PNET and some lymphomas.
madsci
madsci
Thanks for bumping the thread guys--good to see these cases. It inspired me to go digging in my archives for an autopsy case:
4 year old kid, history of white matter/optic nerve lesions, mental status changes, diffuse light skin pigmentation, diffuse lymphadenopathy, and adrenal atrophy. Brain cutting showed diffuse, severe discoloration and granularity of the white matter. Attached are some pictures. Any thoughts?
I'm not saavy enough with inserting images into my text--previewing this, the images look small. I tried looking around to see how to insert images, but I'm not having luck. Any help would be appreciated--I have a couple of heme cases I think would be interesting too, and I'd like to post those.
4 year old kid, history of white matter/optic nerve lesions, mental status changes, diffuse light skin pigmentation, diffuse lymphadenopathy, and adrenal atrophy. Brain cutting showed diffuse, severe discoloration and granularity of the white matter. Attached are some pictures. Any thoughts?
I'm not saavy enough with inserting images into my text--previewing this, the images look small. I tried looking around to see how to insert images, but I'm not having luck. Any help would be appreciated--I have a couple of heme cases I think would be interesting too, and I'd like to post those.
What we've generally done in the past is create an account at some free photo-sharing website (e.g. photobucket.com) that allows you to link to your own images. Takes a while to get past the usual competing priorities, edit the images to a reasonable size, remember the user ID/password combo for the account one hasn't used in months etc...
But at any rate, here is some dermpath for the derm rejects... 😛
Scalp thingie on an adult:
Your Dx?
~
Adding this thread to the "Path info websites"...
But at any rate, here is some dermpath for the derm rejects... 😛
Scalp thingie on an adult:
Your Dx?
~
Adding this thread to the "Path info websites"...
tichoepithelioma?
Same category, but no, that is not the diagnosis.
Posting the diagnosis before I forget:
It's a (hit Ctrl-A):
Panfolliculoma.
Panfolliculoma is a rare follicular neoplasm with differentiation toward both upper (infundibulum and isthmus) and lower (stem, hair matrix, and bulb) segments of a hair follicle.
It's a (hit Ctrl-A):
Panfolliculoma.
Panfolliculoma is a rare follicular neoplasm with differentiation toward both upper (infundibulum and isthmus) and lower (stem, hair matrix, and bulb) segments of a hair follicle.
Elderly man, with a history of TCC of the bladder (papillary, s/p cytoprostatectomy with radiation therapy 2 years ago) Atypical cells on cytology from urethra sampling. The urethra had no gross lesions, but over seemed a bit fibrotic grossly.
Urethra Resection:
Near the Prostatic end
In the Distal half:
Mucin positive (both by H&E and by stain) (the original TCC was not)
Urethra Resection:
Near the Prostatic end
In the Distal half:
Mucin positive (both by H&E and by stain) (the original TCC was not)
Did you do a CDX2?
Was this an invasive adenoca from the colon vs prostatic ductal adenoca?
Was this an invasive adenoca from the colon vs prostatic ductal adenoca?
No, and he had no Prostatic CA on his prior resection, or currently any colon masses.
IHC CK7, CK20 (kind of focal) , CEA positive. PSA Negative.
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AdenoCA. Could still be prostate, try PsAP, HMWCK and p63 to try to eval bladder vs prostate. Urothelial can differentiate into glandular commonly, so it certainly doesn't rule out UC. Of course, could also be arising from some small bizarre structure that usually minds its own business.
Adenocarcinoma
top
1-2% of bladder carcinomas
Defined as malignant tumor differentiated towards colonic mucosa
2/3 occur in men; mean age 68 years
Usually present with hematuria
5 year survival is 20-40%; stage is most important prognostic feature
Restrict diagnosis to pure adenocarcinomas
Either in situ, urachal (1/3, not actually part of adult bladder) or non-urachal (2/3), or clear cell
Gross: 2/3 are single lesions; fungating masses invade bladder wall and ulcerate the mucosa; tumor surface is covered by gelatinous material
Micro: glandular component predominates, usually resembles colonic carcinoma; often produces mucin, usually deeply invades muscularis propria; almost all are considered high grade at diagnosis
Cytology: high grade, but often lack features of glandular differentiation; rarely are well differentiated and appear benign
Positive stains: CK7, CEA, EMA, CDX2, membranous staining for beta-catenin
Negative stains: PSA, vimentin; variable PAP, CA-125 and CK20
References:Hum Path 1986;17:939 (PAP staining), AJSP
2003;27:303 (CDX2)
This is why I hate CDX2. We treat it like a GI marker, but it seems to stain lots of adenos.
Ah well, what do they say. The only specific markers are the understudied markers.
PsAP was negative in the tumor. The HMWCK stained some of the tumor and the basal cells of the urethra and some of the normal gland structures.
Answer: (ctrl A or just highlight with the mouse)
Adenocarcinoma arising from either the Cowper's glands, or the glands of Littre'.The later seems more likely with the association and the most distal position of the tumor.
Normal glands with urethra
