Path Pics Flashcards
normal placenta
first trimester chorionic villi: central stroma surrounded by two layers of epithelium
double arrow (outer layer): syncytiotrophoblasts
single arrow (inner layer): cytotrophoblasts
normal placenta
third trimester chorionic villi: stroma with dense network of dilated capillaries surrounded by markedly thinned out syncytiotrophoblast and cytotrophoblast
Listeria: non-pasteurized milk, cheese
NECROTIZING INTERVILLOSITIS
chorioamnionitis: maternal inflammatory response
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
chronic villitis with CMV (OWL EYE nuclear inclusion)
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
Fetal Membranes
Neg. iron stain
MECONIUM in amnionic cavity
choroinic villi of plactenta
left: first trimester
right: 3rd trimester (increased vascularity)
cells: outer: syncytiotrophoblasts; inner: cytotrophoblasts
ectopic pregnancy in uterine tube
placenta accreta
placental villi interdigitate directly with the uterine myometrium, without an intervening decidual plate
abruptio placenta
BLOOD
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
Potters sequence
cranial anomalies, clubbed feet, pulmonary hypoplasia
due to oligohydramnios
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
placenta
Preeclampsia
villous ischemia: increased syncytial knots (purple nubbins on villi)
maternal vessels in decidua
Preeclampsia
fibrinoid necrosis
Complete hydatidiform mole
villous enlargement, edema, and circumferential trophoblast proliferation
ultrasound
Complete hydatidiform mole
SNOWSTORM
Partial hydatidiform mole
villi: some normal, others swollen, avascular and grape-like
minimal trophoblastic proliferation
Complete hydatifiform mole
grape-like
Partial hydatidiform mole
Choriocarcinoma
NO villi
mitoses
cytotrophoblasts, syncytiotrophoblasts
Choriocarcinoma
proliferating syncytiotrophoblasts, cytotrophoblasts
NO villi
mitoses
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
Invasive Ductal Carcinoma
Lobular 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
