Macroscopie Flashcards by Juliana Jaques

Oeil

Donnez 3 ddx

Leiomyoma
Leiomyoma is a benign, smooth muscle tumor. Ninety percent of cases occur in women. The differential diagnosis includes amelanotic melanoma and nerve sheath tumors.
This transversal pupil–optic nerve (PO) section of an enucleation specimen shows a nodular, well-delineated,
whitish tumor in the ciliary body. The cut surface shows small foci of hemorrhage without necrosis. The retina partially covers the inner surface of the tumor, and the sclera is not infiltrated. Note the slightly displaced (subluxated) cataractous lens and the choroidal detachment artifact in the right inferior corner.

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Enfant avec leukocoria (pupille blanche)

Retinoblastoma
Retinoblastoma is the most frequent intraocular tumor in children. It usually affects patients younger than 2 years. Leukocoria is the major clinical sign. The tumor arises in the sensory retina, and can be endophytic, exophytic, or diffuse.
In this enucleation specimen, the eye is sectioned to show the posterior pole and above the optic nerve, revealing an endophytic tumor; the rest of the retina is diffusely infiltrated. Note the retinal vessels overlying the area of the tumor.
ddx de leukocorie https://eyewiki.aao.org/Leukocoria

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Jeune enfant

Exophytic retinoblastoma
This type of tumor grows from the retina toward the choroid. In this enucleation specimen, the retina is completely detached, and the tumor is growing inside the subretinal proteinaceous fluid. Note the distance between the tumor and the optic nerve head.

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Adulte 70 ans

Uveal melanoma
Uveal melanoma is the most common primary eye malignancy in adulthood, occurring mainly after age 60. The uveal tract, composed of the iris, ciliary body, and choroid can be affected by uveal melanoma.
The enucleation specimen in (A) shows a firm, dome-shaped, deeply pigmented tumor arising from the ciliary body (arrow). The lens has been removed, and a diffuse retinal detachment artifact is present. The enucleation specimen in (B) shows a large, dome-shaped, mixed melanotic and amelanotic choroidal melanoma. The anterior chamber is closed, and the angle is infiltrated (arrow). Total secondary retinal detachment with subretinal serous fluid and some subretinal hemorrhages are present (arrowhead). The lens is cataractous.

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Mélanome uvéal
This enucleation specimen shows a pigmented dome-shaped choroidal melanoma (arrow). The cataractous lens is dislocated (*) and the retina is folded (•).

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Sinus paranasal

Sinonasal inflammatory polyp
Sinonasal inflammatory polyps have multifactorial etiology
including allergy, infection, aspirin hypersensitivity, asthma, cystic fibrosis, and diabetes that results in lamina propria expansion filled by fluid, protein, and fibrosis. These polyps commonly occur in nose and paranasal sinuses, and are most often seen in adults older
than age 20, with the exception of patients with cystic fibrosis who develop them in their first and second decades. Patients present with rhinorrhea, nasal stuffiness, obstruction, and headache.
In (A), an endoscopic view shows a pedunculated edematous polyp with visible fine vessels on the surface. In (B), the resected polyp shows a characteristic ‘‘teardrop” appearance.

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Sinus maxillaire

Fungus ball
A fungus ball is a mass formed by continuous growth of fungal organisms in a sinus, usually the maxillary sinus.
This image shows an endoscopic view of a fungus ball resembling gelatinous peanut butter.

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Glande parotide

Pleomorphic adenoma
Pleomorphic adenoma is the most common type of salivary gland tumor and the most common tumor of the parotid gland.
This resected parotid gland tumor shows a characteristic gelatinous, chondroid, gritty cut surface.

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Glande salivaire majeure

Warthin tumor
Warthin tumor is the second most common benign tumor of the major salivary glands. It is strongly associated with cigarette smoking and can be bilateral.
The cut surfaces of this resected tumor show an encapsulated, tan-brown mass containing multiple cysts (cyst fluid has solidified after formalin fixation).

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Glande parotide

Oncocytoma
Oncocytomas are rare, benign, well-circumscribed tumors
exclusively composed of oncocytes, and are usually found in patients in their fifth and seventh decades of life. Oncocytomas are susceptible to central hemorrhage and infarction.
This specimen illustrates the typical mahogany brown cut surface of oncocytoma. Focal cystic change is visible.

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Palais mou

Mucoepidermoid carcinoma (MEC)
MEC is considered the most common malignant tumor of the major and minor salivary glands.
This MEC is located in the submucosa of the soft palate (arrows) without involvement of the overlying mucosa tissue.

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Peau joue

Merkel cell carcinoma
Merkel cell carcinoma is a neuroendocrine carcinoma of the skin with a predilection for the head-and-neck region, extremities, and buttocks.
This image shows dome-shaped nodular lesions with purple tinge, which is typical of Merkel cell carcinoma. The recurrent tumor in this image had deep extension into the parotid gland.

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Mandibulectomie

Lésion associée à la troisième molaire

Unicystic ameloblastoma
The unicystic variant of ameloblastoma is usually found in the third molar and is associated with an unerupted tooth.
This image shows a largely cystic mass from the mandible with a minor solid component.

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Langue, glossectomie partielle

Adulte fumeur

Squamous cell carcinoma (SCC)
SCC accounts for approximately 95% of all oral cavity
malignancies. Risk factors for SCC include tobacco use, alcohol consumption, radiation, immunosuppression.
This centrally ulcerated tumor of the lateral tongue shows an endophytic growth pattern. The tumor size is larger on cut surfaces than the mucosal lesion, which is a common phenomenon in oral SCC.

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Muqueuse orale

Adulte fumeur, pas de ganglions atteints, pas de métastase

Verrucous carcinoma
Verrucous carcinoma is a well-differentiated, locally invasive
carcinoma associated with cigarette smoking. It does not metastasize to the lymph nodes and there is no definite association with HPV.
This image shows a verrucous carcinoma of the buccal mucosa with a characteristic broad base and warty appearance.

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Gencive

Mucosal melanoma
Mucosal melanoma is a rare form of melanoma arising from melanocytes in the mucosal surfaces of the body lining the sinuses, nasal passages, oral cavity, vagina, anus, and other areas. It has a high recurrence rate after resection. Palate and gingiva are the most common sites.
This brown-black tumor of the maxillary gingiva (arrows) has a nodular appearance.

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Cordes vocales A: à la parole, B: à la respiration

Nodule or polyps of the vocal cord
Vocal cord nodules and polyps are caused by stromal reactions to trauma or inflammation.
These images show a wide-based, translucent polyp (arrows) in the middle portion of the left vocal cord.

Diagnostic et localisation

Laryngectomie ouverte en postérieur, l’épiglotte en haut de l’image

Carcinome épidermoïde supra-glottique
The ulcerating tumor pictured here is above the vocal cord and involves the epiglottis; therefore, it is a supraglottic SCC.
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SCC of the larynx
More than 95% of laryngeal tumors are SCCs. For staging purposes, the larynx is divided into 3 anatomical regions: the glottis (true vocal cords, anterior and posterior commissures); the supraglottis (epiglottis, arytenoids and aryepiglottic folds, and false cords); and the subglottis.

Diagnostic et localisation

Larynx

Carcinome épidermoïde glottique et sous-glottique
This image shows an anterior subglottic and glottic SCC. This tumor presented as a poorly defined ulcer in the anterior midline (arrow).

Diagnostic et localisation

Corde vocale immobile à la laryngoscopie, stade?

Carcinome épidermoïde glottique
This image shows a T3 glottic tumor invading the vocal cords with vocal cord fixation. The tumor on the right vocal cord shows minor supraglottic extension.

Larynx

Diagnostic et localisation

This image shows a glottic and subglottic SCC with right anterior extension. The deep, ulcerating tumor is fixing the vocal cord to the larynx.

Larynx

Diagnostic et localisation

Carcinome épidermoïde transglottique
The tumor in this image extends from the supraglottic to subglottic region and involves the vocal cords; it is therefore considered a transglottic carcinoma.

Carotide

Carotid body paraganglioma
The carotid body is the most common location for head and neck paragangliomas. They are well-circumscribed, firm, rubbery tumors with yellow, tan-to-pink, red, or brown cut surfaces. They can measure from 2 cm to 8 cm.
Paragangliomas are often removed along with a vessel; notice the vessels at the periphery of the tumor.

Thyroïde

Multinodular goiter
Multinodular goiters occur more often in individuals from iodine-deficient areas, older individuals, and women.
These thyroid specimens are distorted due to an asymmetrically enlarged lobe.

Thyroïde

Femme de 40 ans, constipation

Chronic lymphocytic thyroiditis (Hashimoto thyroiditis)
The thyroid gland is often symmetrically enlarged with less prominent nodularity. The thyroid gland is often symmetrically enlarged with less prominent nodularity.

Thyroïde

Papillary thyroid carcinoma
Papillary thyroid carcinoma is the most common type of thyroid cancer (75% to 85% of cases), and is more frequently seen in women aged 20 to 55 years. Previous radiation to the head and neck is a known risk factor for papillary thyroid carcinoma. The tumor is often well differentiated and slow growing.
These images show a papillary thyroid carcinoma with cystic change. Note the typical papillary projections of
variably sized cysts on the wall.

Thyroïde, palpitations

Graves disease
The resected specimen from this patient with known
clinical Graves disease shows diffuse, beefy-red enlargement of the thyroid gland.

Parathyroïdes

3 syndromes associés

Parathyroid hyperplasia
It may occur sporadically or as part of 3 inherited syndromes: multiple endocrine neoplasia type 1 (MEN 1), multiple endocrine neoplasia type 2A (MEN 2A), and isolated familial hyperparathyroidism.

Parotide, 2 réaarangements