Images Flashcards
What pathology is seen in the images above?
(normal is below)
Acute Amnionitis due to Amnionic Fluid Infection (Ascending)
Gross: dull, opaque membranes with yellow-green discoloration
Histo: numerous neutrophils indicative of acute inflammatory response — result of the maternal response to infection of the amniotic fluid.
**These features are seen in association with ascending infection. In hematogenous (transolacental) infection, you will see acute villitis.
What pathology is seen in this placenta (top - gross, bottom - histo)?
Gross image shows 2 recent infarcts.
These are seen in histo slide beneath.
Left = Coagulative necrosis / ischemic tissue
Middle = Blue-ish area = margin of inflammation
Right = Viable parenchyma
What pathology is seen here?
Is this due to solely local effects or also systemic?
Severe Preeclampsia
The attempt to increase pressures to meet placental demand results in endothelial shearing and fibrinoid necrosis (*) of the decidual vessels (decidual vasculopathy).
This endothelial injury appears to be mediated not only by local pressures but systemic factors as well. This is why endothelial injury (& subsequent intravascular coagulation) can be seen in other organs (kidney, liver, brain), leading to the hemolysis, thrombocytopenia, proteinuria, transaminitis, and (in eclampsia) seizures seen in this disease.
What is Placenta Abruption (abruptio placenta)?
Complication of Placenta pre via - results when the placenta starts separating from the uterus before labor. This results in accumulation of blood between the placental disc and uterus. The clot that collects lifts the placental disc off the uterus and can result in compression of the placental parenchyma.
This parenychmal compression could also damage the villi in this region and lead to fetal distress.
This ultrasound is seen in the 2nd trimester of pregnancy. What is the diagnosis?
Molar pregnancy (anucleate ovum fertilized – no fetus)
The following histology is seen on biopsy of an aborted fetus. What is the Dx?
Molar pregnancy
Description: Swollen (edematous) villi, with circumferential trophoblastic proliferation & nuclear atypia
(would also see “bunch of grapes” on gross appearance, seen here)
Endometrial Hyperplasia:
Classify each example shown.
Left = Simple
Right = Complex, Atypical
Label A - D
A. Surface Epithelium
B. Cortex
C. Medulla
D. Corpus Luteum (granulosa cells)
Diagnosis?
Ovarian Endometriosis
Ovary surface with endometriosis (“power burns” appearance)
Dx?
Benign Serous Cystadenoma
or
Serous Borderline Tumor
or
Serous Cystadenocarcinoma (malignant)?
Benign: Serous Cystadenoma
Unilocular or multilocular cyst lined by serous epithelium
Dx?
Benign Serous Cystadenoma
or
Serous Borderline Tumor
or
Serous Cystadenocarcinoma (malignant)?
Serous Borderline Tumor:
cyst with areas of papillary excrescences
Dx?
Benign Serous Cystadenoma
or
Serous Borderline Tumor
or
Serous Cystadenocarcinoma (malignant)?
High Grade Serous Carcinoma (Malignant)
(aka Serous Cystadenocarcinoma)
Cystic and solid, papillary growth, necrosis, hemorrhage
Dx?
- Precursor for a subset of serous carcinoma
- Positive for p53
Serous Tubal Intraepithelial Carcinoma
Top arrow = STIC: highly atypical cells
Bottom arrow = Normal fallopian tube lining
Diagnosis?
Mucinous Cystadenoma
Gross: large cyst filled with viscous fluid
Microscopic: mucinous epithelial lining
Diagnosis?
Ovarian Clear Cell Carcinoma
Which endometriosis-ass’d cancer is this?
Ovarian Endometrioid Adenocarcinoma
Dx = PID
Pathogen?
Chlamydia trachomatis
Dx = PID
Pathogen?
Neisseria gonorrhoeae
Diagnosis?
Neonatal HSV
Localized to skin, eyes, mouth – 45%
CNS infection – 30%
Disseminated disease – 25%
Mortality: approx 30%
Long term CNS sequelae : approx 20%.
What is the arrow pointing to?
Zona pellucida
“Developing oocyte surrounded by granulosa with zona pellucida (arrow)
What are the arrows pointing to?
Top = Theca cells
Bottom = Granulosa cells
“Mature (“Antral”) follicle surrounded by differentiated follicular cells, containing a horseshoe-shaped central antrum of fluid and the oocyte in the center”
Diagnosis?
Intraductal Papilloma
- Papillomatous growth within the lumen of large or small lactiferous ducts
- Grow from the wall of a cyst into it’s lumen
Diagnosis?
Mild Ductal Hyperplasia
A proliferation of cytologically benign epithelial cells fills and distends the duct. The nuclei vary in size, shape, and placement. The spaces within the duct are also variable in size and contour
Diagnosis?
Florid Ductal Hyperplasia
Diagnosis?
Atypical Ductal Hyperplasia
Atypical ductal hyperplasias are lesions that have some of the architectural and cytologic features of low-grade DCIS, such as nuclear monomorphism, regular cell placement and round regular spaces, in at least part of the involved space. The cells may form tufts, micropapillations, arcades, bridges, solid, and cribiform patterns. A second cell population with features similar to those seen in usual ductal hyperplasia is also typically present
Diagnosis?
Atypical Lobular Hyperplasia
The acini of this lobule contain a proliferation of small uniform cells, which are dyshesive, and are identical to the cells that comprise lobular carcinoma in situ. However, the acini are not distended by this cellular proliferation
Diagnosis?
Mucinous (Colloid) Carcinoma
** Islands of tumor cells are seen floating in lakes of extra-cellular mucin (arrow)
Diagnosis?
Label each arrow
Medullary Carcinoma
Top Left = Stromal Lymphocytes
Bottom Left = Tumor Cells
Top Right = Tumor Edge
Type of Metaplastic CA?
Bone Forming
Type of Metaplastic CA?
Spindle Cell
Type of Metaplastic CA?
Squamous Cell
IDC- Usual Type (NOS)
Which is High-grade & which is Low-grade?
Immunohistochemical stain for high molecular weight cytokeratin shows _____ cells around normal prostatic glands.
basal
Diagnosis?
BPH
Left = Stromal hyperplasia
Right = Glandular hyperplasia
Diagnosis?
DCIS
(microcalcifications)
Diagnosis?
DCIS (comedo-type)
Diagnosis?
DCIS (cribriform type)
Diagnosis?
DCIS (solid type)
Diagnosis?
ILC
(Single file arrangement)
Diagnosis?
ILC
(Targetoid growth around ducts)
Diagnosis?
Invasive Ductal CA
(no special type)
Diagnosis?
LCIS
Diagnosis?
Medullary CA
Diagnosis?
Mucinous CA
Diagnosis?
Paget’s Disease
(intraepidermal malignant cells from underlying DCIS)
Diagnosis?
Paget’s Disease
(here’s another pic)
Diagnosis?
Spermatocytic Seminoma
Diagnosis?
Acute Bacterial Prostatitis
- Sheets of neutrophils with abscess formation
- Ducts packed with neutrophils and necrotic debris
Diagnosis?
Chronic Bacterial or Non-bacterial Prostatitis
(both look the same)
Lymphocytes in the stroma and prostatic glands
Diagnosis?
Mixture of histocytes, lymphocytes, plasma cells, eosinophils, neutrophils, and giant cells arranged in sheets without formation of discrete granulomas
Diagnosis?
Post-Transurethral Resection Granulomatous Prostatitis
- Resemble rheumatoid nodules.
- Central zone of fibrinoid necrosis.
- Rim of palisaded epithelioid histocytes.
- Variable numbers of multinucleated giant cells.
Diagnosis?
Post-BCG Prostatitis
- Diffuse, discrete granulomas
- With or without caseating necrosis
- Acid-fast bacilli can be identified (rarely)
Diagnosis?
High-grade PIN
Note the large glands w/ proliferation of atypical epithelium (tufted & micropapillary patterns)
Diagnosis?
High grade PIN (High Magnification)
Note the cytological atypia with the nuclear enlargement
and prominent nucleoli.
Prostate Carcinoma:
which arrow is pointing to malignant vs. benign glands?
Top right = Malignant
Bottom Left = Benign
*Malignant glands are small and medium in size.
Gleason Grade?
Gleason Grade 1
- Circumscribed nodule with closely packed, uniform glands in transition zone
- Very uncommon pattern
Gleason Grade?
Gleason Grade 2
- Less circumscribed nodule with loosely packed, less uniform (branching and irregularity) glands.
- Uncommon in peripheral zone.
Gleason Grade?
Gleason Grade 4
Fused glands without intervening stroma.
