Path Pics Flashcards by Savannah Smith

normal placenta

first trimester chorionic villi: central stroma surrounded by two layers of epithelium

double arrow (outer layer): syncytiotrophoblasts

single arrow (inner layer): cytotrophoblasts

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normal placenta

third trimester chorionic villi: stroma with dense network of dilated capillaries surrounded by markedly thinned out syncytiotrophoblast and cytotrophoblast

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Listeria: non-pasteurized milk, cheese

NECROTIZING INTERVILLOSITIS

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chorioamnionitis: maternal inflammatory response

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Umbilical Cord

INFECTION

top: phlebitis, arteritis in umbilical arteries and veins
middle: necrotizing funisitis due to long standing infection (right)
bottom: peripheral funitis (inflammation at periphery of umbilical cord) with CANDIDA

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chronic villitis with CMV (OWL EYE nuclear inclusion)

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left: Bone Marrow
right: placenta

Parvovirus B19: ERYTHEMA INFECTIOSUM (SLAP CHEEK)

left: viral inclusions in early erythroid precursors
right: erythroblasts in the lumen of capillary vessels of placental villi show eosinophilic nuclear inclusions

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Fetal Membranes

Neg. iron stain

MECONIUM in amnionic cavity

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choroinic villi of plactenta

left: first trimester
right: 3rd trimester (increased vascularity)
cells: outer: syncytiotrophoblasts; inner: cytotrophoblasts

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ectopic pregnancy in uterine tube

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placenta accreta

placental villi interdigitate directly with the uterine myometrium, without an intervening decidual plate

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abruptio placenta

BLOOD

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Amnion Nodosum

gross: multiple yellow tan superficial amniotic lesions, usually near insertion of umbilical cord
micro: nodules of eosinophilic fibrous material with entrapped squamous cells

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Potters sequence

cranial anomalies, clubbed feet, pulmonary hypoplasia

due to oligohydramnios

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Preeclampsia

top: small placenta due to preeclampsia
bottom: placenta with pale infarct (more than 1/3 to 1/2 becomes infarcted: blood supply to infant can become compromised and cause fetal demise)

can also find hematomas

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placenta

Preeclampsia

villous ischemia: increased syncytial knots (purple nubbins on villi)

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maternal vessels in decidua

Preeclampsia

fibrinoid necrosis

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Complete hydatidiform mole

villous enlargement, edema, and circumferential trophoblast proliferation

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ultrasound

Complete hydatidiform mole

SNOWSTORM

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Partial hydatidiform mole

villi: some normal, others swollen, avascular and grape-like

minimal trophoblastic proliferation

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Complete hydatifiform mole

grape-like

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Partial hydatidiform mole

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Choriocarcinoma

NO villi

mitoses

cytotrophoblasts, syncytiotrophoblasts

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Choriocarcinoma

proliferating syncytiotrophoblasts, cytotrophoblasts

NO villi

mitoses

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Necrotizing enterocolites (NEC) A: entire small bowel is distended with perilously thin wall (impending perforation) B: congested ileum: hemorrhagic infarction and transmural necrosis arrows: submucosal gas bubbles (pneumatosis intestinalis)

right: Hyaline membrane disease (eosinophilic thick hyaline, atelectasis of alveoli) left: normal fetal lung

hydrops fetalis fluid accumulation: particularly prominent in soft tissue of neck (CYSTIC HYGROMA: classic in 45X)

Fibrocystic changes | (yellow is fat)

Fibrocystic change Pos. if stain for myoepithelial

Fibrocystic change: non-proliferative APOCRINE METAPLASIA

normal breast duct

Fibrocystic change: proliferative USUAL DUCT HYPERPLASIA lumen full of mixed population of luminal and myoepithelial cells irregular slit-like fenestrations at periphery

Fibrocystic change: proliferative with atypia ATYPICAL DUCTAL HYPERPLASIA monomorphic proliferation of regularly spaced cells sometimes with cribiform spaces (looks like DCIS)

Fibrocystic change: proliferative with atypia ATYPICAL LOBULAR HYPERPLASIA cells identical to thos in lobular carcinoma in situ but cells do not fill or distend more than 50% of then acini within a lobule

Fibrocystic change: proliferative SCLEROSING ADENOSIS terminal duct lobular unit is enlarged, acini are compressed and distorted by dense stroma calcifications in some lumens acini in SWIRL pattern and outer border is well circumscribed

Fibrocystic change: Prolifertive RADIAL SCLEROSING LESION A: irregular central mass with long radiodense projections B: solid with irregular borders, but not as firm as invasive CA C: central nidus of small tubules entrapped in a densely fibrotic stroma with epithelial projections with cyst formation and hyperplasia

Fat Necrosis infarcted cells surrounded lipid-laden macrophages fibrosis, calcifications

moveable

Fibroadenoma

Fibroadenoma glands AND stroma looks like a constellation

Fibroadenoma ducts AND stroma CONSTELLATION

Phyllodes tumor LEAF like distinguished from fibroadenoma by: higher cellularity, higher mitotic rate, nuclear pleomorphism, STROMAL overgrowth, infiltrative borders

Phyllodes tumor: MALIGNANT STROMA overgrowth, lots of mitotic figures, densely packed ANAPLASTIC stromal cells, INFILTRATIVE border, tumor necrosis

Intraductal Papilloma central fibrovascular core extending from wall of duct: lined by BOTH myoepithelial cells and luminal cells

Breast

BRCA1 mutation: (high incidence of medullary and DCIS) high grade, abundant intra and peritumoral lymphocytes

Breast

BRCA2 high grade features and pushing tumor margin (invasive ductal CA, DCIS)

DCIS: cribiform type

high grade DCIS: COMEDO type

LCIS uniform low grade monotonous cells intracellular target mucin loss of E-CADHERIN

LCIS

Invasive Ductal Carcinoma atypical ducts in stroma

Invasive Ductal Carcinoma

Lobular Carcinoma

Invasive Lobular Carcinoma INDIAN FILE bland, usually estrogen pos.

Breast Associated with what mutation? Reoccurence risk?

Medullary Carcinoma high grade cells growing in sheets; lymphocytes and plasma cells BRCA1, reccurences are rare

Meduallary Breast Carcinoma indistinc cell borders (syncytial growth), large pleomosphic tumore cells with large nuclei, prominent nucleoli, mitotic figures lymphoplasmacytic infiltrate at periphery pushing borders/well circumscribed

Breast Prognosis? Age?

Colloid/ Mucinous Carcinoma good prognosis older women: around 70 yrs

Breast Prognosis?

Tubular carcinoma distinct well differentiated angular tubular structures (tadpoles), open lumina, lined with single layer of epithelial cells good prognosis

Breast Prognosis?

Micropapillary variant poor prognosis (most have lymph node metastases at presentation, recurrence, half die)

Breast

Paget's Disease of Nipple due to underlying CA

Breast with NO palpable mass Prognosis? Micro?

Inflammatory Carcinoma (reoccurence) enlarged swollen erythematous breast top arrows: inflammation bottom arrow: mastectomy scar Poor prognosis (survival less than 1/2; even lower with metastases) poorly differentiated, diffusely infiltrative

Peau d'orange thickened skin due to lymphatic congestion

Male: breast

gynecomastia NO lobules, increase ducts, prominent stroma; can be edematous with incresased cellularity late phase may have fibrosis

Herpes margination, molding, multinucleation

Transmission?

Molluscum contagiosum (pox virus) children: direct contact or shared objects adults: sexually transmitted

How might a women get this?

Candida pseudohyphae result of disturbacne of vaginal microbial ecosystem: DM, antibiotics, pregnancy, compromised immune system

Symptoms?

Trichomonas vaginalis (protozoan) Sx: YELLOW, FROTHY vaginal discharge; vulvovaginal discomfor, dysuria, dyspareunia bottom: marked dilatation of cervical mucosal vessels resulting in STRAWBERRY CERVIX

Symptoms?

Gardnerella vaginalis (G- bacillus) Sx: thin GRAY, FISHY discharge CLUE cell

PID top: normal fallopian tube A: acute salpingitis: dilated lumen and edematous tubal plicae (folds) expanded by inflammatory cell infiltrates, pus in center of tube B: chronic salpingitis with scarring and fusing of plicae

What causes this to occur?

Fitz-Hugh-Curtis syndrome (PERIHEPATITIS) caused by: PID

Vulva Differential?

LEUKOPLAKIA: white patch, atrophy of skin, vaginal stenosis Differential: squamous cell carcinoma, Lichen Simplex Chronicus, Lichen Sclerosis

Lichen Sclerosis thinned epidermis, sclerosis of superficial dermis, chronic inflammatory cells

Lichen Simplex Chronicus Thickened epidermis

Cause?

Condyloma Accuminatum: HPV 6 and 11 koilocytic cell, binucleate, clear around nucleus

Vulva

HPV pos. Vulvar Intraepithelial Neoplasia (VIN) whole surface looks the same: basal cells left: in situ right: invasive (can't see BM) NON-KERATINIZING: younger women

Vulva

HPV neg. Vulvar Intraepithelial Neoplasia (VIN) KERATINIZING: older woman

Vulva

Paget disease intraepithelial proliferation of malignant cells confined to epidermis

Vagina: Less than 5 years old Death caused by?

Embryonal Rhabdomyosarcoma: Sarcoma Botryoides RHABDOMYOBLAST death: penetration into peritoneal cavity or obstruction of urinary tract

Cervix Where is the highest viral load?

High risk HPV: Raisin nuclei, Binucleate, Koilocytic with clearing around nuclei Left: normal left middle: CIN I right middle: CIN II (mitotic figure in middle to top area) right: CIN III do not need low grade lesion to develop high grade lesion highest viral load: top

Cervix Stain(s)?

HPV infection Stain: p16 and Ki-67 A: LSIL B: dark granular staining denotes HPV DNA abundant in koilocytes C: Ki-67 brown nuclear stain, abnormal expansion of proliferating cells D: upregulation of p16 (brown stain) characterized high risk HPV infection

Cervix

Invasive squamous cell carcinoma top: microinvasion in CIN III bottom: keratin

Cervix

left: adenocarcinoma in situ right: invasive adenocarcinoma

Cervix cytology

top left: normal top right: LSIL bottom: HSIL

Tissue? Phase?

endometrium: proliferative phase columnar epithelium with tubular glands

Tissue? Phase?

Endometrium: secretory phase

Endometrium: Phase?

top: early secretory bottom: late secretory

Tissue? Phase?

endometrium: menstrual phase clumps of cells and glands with BLOOD

Uterus

polyp

Uterus What drug can cause this?

Endometrial Polyp cystic change, large thick walled vessels, fibrous stroma Drug: Tamoxifen

Endometrium Common cause? Tx?

Acute Endometritis common cause: retained products of conception Tx: antibiotics, D&C

Endometrium Associations?

Chronic Endometritis PLASMA CELLS assoiciated with: PID, retaind gestational tissue, IUD, TB (miliary or drainage from tuberculosis salpingitis)

Woman with Cu IUD with bad smelling discharge

Actinomyces sulfur granuloma pseudofilamentous material with ACUTE ANGLE branching G pos. bacteria

Outside of uterus

endometriosis

Outside of Uterus What 3 things are required for Dx?

Endometriosis endometrial glands, stroma, hemosiderin

Endometrium

left: Simple hyperplasia no atypia (mild glandular crowding and cystic glandular dilation) right: normal proliferation

Endometrium

Complex hyperplasia no atypia increased glandular crowding with areas of back to backglands and cytologic features similar to proliferative endometrium

Endometrium

Complex hyperplasia with atypia very little stroma (CA will have NONE)

Endometrium

complex hyperplasia with atypia very little stroma, apoptotic debris

Endometrium Grade?

Endometrioid Carcinoma (hyperplasia pathway) top right: Grade 1 (less than 5% nonsquamous growth pattern) bottom left: Grade 2 (6-50%) bottom right: Grade 3 (greater than 50%)

Endometrium Grade? Stain?

Serous Carcinoma (sporadic pathway) grade 3 for any histologic pattern stain: p53

Endometrium

Malignant Mixed Mullerian Tumor (MMMT) aka carcinosarcomas left: epithelial and stromal components appear to be derived from same cell right: only epithelial components: tumors with heterologous mesenchymal components do worse poor prognosis

Leiomyoma

Leiomyosarcoma

Ovary

Follicular Cyst granulosa lining cells present if intraluminal pressure not so great to cause atrophy theca cells may be conspicuous due to increased amount of pale cytoplasm

Ovary

Corpus Leuteal Cyst present in normal ovaries of reproductive women lined by rim of bright yellow tissue containing luteinized granulosa cells occasionally rupture: peritoneal rxn

Ovary

serous cystadenoma stromal papillae with a columnar epithelium

Ovary

Serous Cystadenofibroma

Ovary

Borderline Serous tumor increased architectural complexity and epithelial cell stratification

Ovary

Serous Carcinoma left: low grade (complex micropapillary growth) right: high grade (invasion of underlying stroma)

Ovary Mutation? How to tell benign vs. malignant?

Mucinous cystadenoma benign: fluid malignant: papillary solid stuff, stromal invasion mutation: KRAS

extensive mucinous ascites, cystic epithelial implants on peritoneal surfaces, adhesions, frequent involvement of ovary source?

pseudomyxoma per-itonei usually from appendix

Ovary What pathology might this co-exist with?

endometrioid adenocarcinoma some have: endometriosis

Ovary Associated with?

right: Brenner tumor (resemble urothelium) associated with: left: teratoma

Ovary origin?

Kruckenberg tumor origin: gastric bilateral: mucin producing, SIGNET RING cells

Ovary Secrete? Behave? IHC Ab?

Granulosa tumor CALL EXNER bodies: small follicle like structures secrete: estrogen behave: low grade malignancy Ab: inhibin

Ovary Associated syndrome(s)?

Fibroma, Fibrothecoma, Thecoma Meigs syndrome and basal cell nevus syndrome

Ovary Secrete?

Sertoli Leydig cell tumor produce: testosterone (occasionally estrogen) masculinization

Ovary

Mature Teratoma

Ovary

Mature Teratoma left: neural tissue, middle: hair

Ovary Risk for extraovarian spread?

Immature Teratoma resembles embryonal and immature fetal tissue risk for spread: grade of tumor based on proportion of tissue containing NEUROEPITHELIUM

Ovary

Struma Ovarii: monodermal teratoma thyroid tissue

Ovary Where else might it be present? Expresses?

Dysgerminoma other places: mediastinum, pineal gland, retroperitoneum express: receptor kinase KIT

Ovary What is elevated in the serum?

Yolk Sac tumor Schiller-Duval body, hyaline droplets serum: AFP

Candida albicans GERM TUBE

Penis Gross? Who in?

Squamous Cell Carcinoma: HPV gross: ulceration who: uncricumcised

Sudden onset of pain Fix by?

Testicular torsion fix within 6 hours

Testis Age? What can be seen in some cases histologically (not this one)?

Seminoma age: 20s and 30s sheets of polygonal cells with lymphocytes in the stroma in some cases: syncytiotrophoblasts

Testis What can happen with chemo?

embryonal carcinoma undifferentiated cells and primitive gland-like structures, large hyperchromatic nuclei chemo: cells can mature and differentiate

Testis Age? Stain for? Circles? what do they resemble?

Yolk sac tumor eosinophilic hyaline globules: alpha1-antitrypsin and AFP Schiller-Duval bodies: loosely textured microcystic tissue and papillary structures resemble glomerulus

Testis Arrowhead? Arrow? IHC and serum? Spread?

Choriocarcinoma cytotrophoblastic cells with central nuclei (arrowhead); syncytiotrophoblastic cells with multiple dark nuclei in eoisinophilc cytoplasm (arrow) IHC and serum: hCG (within syncytiotrophoblasts) Spread: heatagenous hemorrhage, necrosis

Testis More common in? When is it benign? Malignant

Teratoma more common in children than adults benign: pre-pubertal malignant: post-pubertal A: neural (ectoderm) B: glandular/ GI (endoderm) C: cartilaginous (mesoderm) D: squamous epithelial

Prostate most common cause?

Prostatitis cause: E. coli or other GNR

Prostate Stimulus? Sx? Complication?

Bengin prostate hyperplasia: proliferation of STROMAL and GLANDULAR elements 2 layers: BENIGN stimulus: DHT Sx: hesitancy, urgency, nocturia complication: UTI due to obstruction

Prostate location?

Adenocarcinoma lower left: posterior, peripheral

Prostate Grade?

Adenocarcinoma right: shows perineural invasion grade 3: lots of individual glands

Prostate Grades?

Adenocarcinoma top: grade 3 (lots of glands) middle: grade 4 (glands start going together) bottom: grade: 5 (no glands really)

Prostate

Cancer right: only one cell layer with prominent nucleoli

Prostate Stain?

Cancer IHC: RACEMASE brown is normal basal cells of benign gland red: malignant cells

normal urothelium umbrella cells

normal urothelium

top: urteropelvic junction obstruction causes (most common cause): bottom: hydronephrosis can be bilateral

double/bifid ureter unilateral usually

What can this lead to?

diverticula of ureter: outpouching of ureteral wall can cause: urinary stasis with recurrent infection

ureter, renal pelvis, calyces, or bladder

low grade papillary urothelial carcinoma

Ureter Causes? Related to what disease? age?

Sclerosing retroperitoneal fibrosis tubulointerstitial with fibrous and prominent infiltrate of lymphocytes, PLASMA CELLS (IgG4 pos.), eosinophils can cause: ureteral narrowing or obstruction related to: Riedels thyroiditis, IgG4 (elevated IgG4 and fibroinflammatory lesions rich in IgG4 secreting plasma cells) middle to late age

Exstrophy of the bladder

Bladder

Cystitis top: malakoplakia raised mucosal plaques bottom: foamy macrophages (abundant granular cytoplasm), multinucleate giant cells, lymphocytes MICHAELIS-GUTMANN bodies: Ca deposition

Bladder Causes?

Bladder cancer caused by: smoking, occupational (hair dresser), SCHISTOSOMA HAEMATOBIUM

Bladder

Carcinoma in situ flat lesion: umbrella cells are gone and even falling off

Bladder

low grade urothelial carcinoma

Bladder

High grade urothelial carcinoma

Bladder

Invasive urothelial carcinoma

Bladder

Invasive urothelial carcinoma

Bladder 50% have what?

Invasive bladder cancer half have occult metastatic disease

Stain that shows organism?

Syphilis top: chancre, PAINLESS and heal spontaneously bottom: proliferative endarteritis, PLASMA cells stain: silver

Stain?

Syphilis: spirochetes stain: Silver

tertiary Syphilis GUMMA: coagulative necrosis by a mixed inflammatory infiltrate composed of lymphocytes, plasma cells, activated macrophages, giant cells, peripheral zone of dense fibrous tissue

Trichomoniasis

Genital Herpes Simplex nuclear inclusions make them look smudgy and glassy (light on inside and dark on outside)

urethra Tx?

urethral caruncle inflammatory granulation tissue covered by intact friable mucosa which may ulcerate and bleed with slight trauma small, red, painful mass on the external urethral meatus in older females Tx: surgical excision