Path Pics Flashcards
Pleomorphic Adenoma
many in parotid, mucin and myoepithelial cells, cartilage
Warthin Tumor
epithelial and LYMPHOID elements, CYSTIC spaces separate lobules of epithelium (double layer of eosinophilic epithelial cells based on a reactive lymphoid stroma)
Warthin tumor
epithelial, LYMPHOID, CYSTS
Mucoepidermoid Carcinoma
mixed: squamous and mucus secreting cells
top: no stain
bottom: MUCIN stain
Esophagus
GERD
erosions ( this is enought to make Dx but most GERD patients won’t have these)
Esophagus
changes associated with REFLUX (GERD)
edema: pale around cells
Esophagus
right: REFLUX (GERD)
left: normal
EOSINOPHILS, lymphocytes, neutrophils
basal cell hyperplasia, elongated lamina propria papillae, edema/spongoisis, subepithelial vascular dilatation
Biopsy not needed if see erosion on endoscopy
Eosinophilic esophagitis (EoE)
top: ringed esophagus (linear furrows, narrow)
bottom: microabscesses
Esophagus
left: Reflux
right: Eosinophilic esophagitis
more that 20 EOSINOPHILS per HPF in entier esophagus, edema, basal cell hyperplasia
circle: eosinophilic microabscess
Barrett’s esophagus
Esophagus
Barrett’s Esophagus
metaplastic columnar mucosa above the gastroesophageal junction
Esophagus
Major player in progression?
DYSPLASIA in Barrett esophagus
left: LOW grade (hyperchromasia, increased N:C ratio; normal glandular epithelium at arrowhead)
right: HIGH grade (railure of epithelial cells to mature as they reach surface, abnormal architecture, nuclear hyperchromasia, increased nuclear to chromatin ratio, abnromal mitosis)
p53
Esophagus
DYSPLASIA in Barrett esophagus
left: LOW grade (abrubt transition from metaplasia to dysplasia at arrow; nuclear stratification and hyperchromasia)
right: HIGH grade (architectural irregularities (gland within gland and cribiform: anatomical structure pierced by numerous small holes))
Esophagus
Esophageal adenocarcinoma
Left: distal esophagus
Right: mid esophagus
Left: Adenocarcinoma
Right: squamous cell carcinoma (can cause strictures)
Esophagus
Adenocarcinoma
Esophagus
Squamous cell carcinoma
Peptic Ulcer
well circumscribed lesion at top, remaining mucosa is mildly edematous with no associated subepithelial hemorrhage or erosions
Stomach
chronic gastric ulcer
top: cellular debris
middle: fibrinoid necrosis
bottom: granulation tissue
Stomach
left: Active Gastritis (Neutrophils)
right: Chronic Gastritis (Lymphoplasmacytic)
top 2 arrows: NEUTROPHILS in crypt
lumen: H. pylori
right arrow: lymphocytes, PLASMA cells
Stomach
What part of stomach?
H. pylori
ANTRUM
right: silver stain
now also have IHC stain
normal gastric mucosa
Stomach
Reactive/Chemical Gastropathy
crypts and glands more torturous and elongated
little inflammation (no plasma cells or neutrophils really)
Stomach
Intestinal Metaplasia
Stomach
Chronic Follicular Gastritis due to H. pylori
arrow: lymphoid follicle (GERMINAL CENTER): increases risk for MALT to transform into LYMPHOMA
corner: immuno stain for H. pylori
Top Left: Stomach
Top Right and Bottom: small intestine
What is it associated with?
Treatment?
Gastric MALT Lymphoma
A: lymphoepithelial lesions with neoplastic lymphocytes surrounding and infiltrating gastric glands (no glands)
B: disseminated lymphoma: numerous small serosal nodules
C: Large B cell lymphoma infiltrating the small intestinal wall and producing diffuse thickening
H. pylori
Tx: just Tx H. pylori and get better
MALToma
Stomach
Benign Peptic Ulcer
well circumscribed
Stomach
recent hemorrhage of peptic ulcer
Colon
A: normal: see vessels
B: Ulcerative colitis: no vessels, erythema
Colon
Pt: chronic relapsing abdominal pain, bloating, change in bowel habits
left: normal colon
right: Irritable Bowel Syndrome (looks normal)
Colon
Ulcerative Colitis: pseudopolyps
isolated islands of regenerating mucosa bulge into the lumen
Ulcderative Colitis: Active Colitis
top left: neutrophils attacking crypts
bottom left: crypt rupture (looks like granuloma but not)
right: crypt abscesses
Ulcerative Colitis
diffuse inflammation limited to mucosa and superficial mucosa (can’t tell on biopsy how deep bc don’t have whole wall of colon)
Potential cause?
Risk of what?
Toxic Megacolon: colonic dilation
cause: Ulcerative Colitis
risk of perforation
What is this?
What caused it?
What is at arrow?
Acute Ulcerative Colitis (due to immunocompromised state)
arrow: CMV infected cell: looks like a vessel wall; inclusions in nucleus and cytoplasm
Why does this patient have CMV?
What else might they have?
immunocompromised
ulcerative colitis
Colon
Left: Ulcerative Colitis activity
Right in box: Dysplasia (architecture distortion, hyperchromasia, cigar nuclei)
What is this?
What increases the risk for this?
Small Bowel Obstruction
air fluid lines (should not be as many or as prominent in normal patient)
Crohn’s disease can increase risk
bottom arrow: stricture in distal ileum (narrowing)
top left: ascending colon
top right: small intestine
Terminal Ileum
Crohn’s disease
arrow: ulceration
Crohn’s disease
arrow: stricture
intetinal wall is thickend and rubbery due to: transmural edema, inflammation, submucosal fibrosis, hypertrophy of muscularis propria
Crohn’s disease: Fissures
develop btwn mucosal folds, may extend to become fistula (vaginal or perianal) or perforation (gross)
Crohn’s: Creeping Fat
mesenteric fat extends around the serosal surface (second to extensive transmural disease)
Crohn’s disease
crypt abscess: cluster of neutrophils in crypt
Crohn’s disease
architectural distortion due to crypt destruction and regeneration
Crohn’s disease: Noncaseating granuloma
histiocytes that have loosely aggregrated
