Path Pics

Question 1

Answer 1

Pleomorphic Adenoma

many in parotid, mucin and myoepithelial cells, cartilage

Question 2

Answer 2

Warthin Tumor

epithelial and LYMPHOID elements, CYSTIC spaces separate lobules of epithelium (double layer of eosinophilic epithelial cells based on a reactive lymphoid stroma)

Question 3

Answer 3

Warthin tumor

epithelial, LYMPHOID, CYSTS

Question 4

Answer 4

Mucoepidermoid Carcinoma

mixed: squamous and mucus secreting cells
top: no stain
bottom: MUCIN stain

Question 5

Esophagus

Answer 5

GERD

erosions ( this is enought to make Dx but most GERD patients won’t have these)

Question 6

Esophagus

Answer 6

changes associated with REFLUX (GERD)

edema: pale around cells

Question 7

Esophagus

Answer 7

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

Question 8

Answer 8

Eosinophilic esophagitis (EoE)

top: ringed esophagus (linear furrows, narrow)
bottom: microabscesses

Question 9

Esophagus

Answer 9

left: Reflux
right: Eosinophilic esophagitis

more that 20 EOSINOPHILS per HPF in entier esophagus, edema, basal cell hyperplasia

circle: eosinophilic microabscess

Question 10

Answer 10

Barrett’s esophagus

Question 11

Esophagus

Answer 11

Barrett’s Esophagus

metaplastic columnar mucosa above the gastroesophageal junction

Question 12

Esophagus

Major player in progression?

Answer 12

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

Question 13

Esophagus

Answer 13

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))

Question 14

Esophagus

Answer 14

Esophageal adenocarcinoma

Question 15

Left: distal esophagus

Right: mid esophagus

Answer 15

Left: Adenocarcinoma

Right: squamous cell carcinoma (can cause strictures)

Question 16

Esophagus

Answer 16

Adenocarcinoma

Question 17

Esophagus

Answer 17

Squamous cell carcinoma

Question 18

Answer 18

Peptic Ulcer

well circumscribed lesion at top, remaining mucosa is mildly edematous with no associated subepithelial hemorrhage or erosions

Question 19

Stomach

Answer 19

chronic gastric ulcer

top: cellular debris
middle: fibrinoid necrosis
bottom: granulation tissue

Question 20

Stomach

Answer 20

left: Active Gastritis (Neutrophils)
right: Chronic Gastritis (Lymphoplasmacytic)

top 2 arrows: NEUTROPHILS in crypt

lumen: H. pylori

right arrow: lymphocytes, PLASMA cells

Question 21

Stomach

What part of stomach?

Answer 21

H. pylori

ANTRUM

right: silver stain

now also have IHC stain

Question 22

Answer 22

normal gastric mucosa

Question 23

Stomach

Answer 23

Reactive/Chemical Gastropathy

crypts and glands more torturous and elongated

little inflammation (no plasma cells or neutrophils really)

Question 24

Stomach

Answer 24

Intestinal Metaplasia

Question 25

Stomach

Answer 25

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

Question 26

Top Left: Stomach Top Right and Bottom: small intestine What is it associated with? Treatment?

Answer 26

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

Question 28

Answer 28

MALToma

Question 29

Stomach

Answer 29

Benign Peptic Ulcer well circumscribed

Question 30

Stomach

Answer 30

recent hemorrhage of peptic ulcer

Question 31

Colon

Answer 31

A: normal: see vessels B: Ulcerative colitis: no vessels, erythema

Question 32

Colon Pt: chronic relapsing abdominal pain, bloating, change in bowel habits

Answer 32

left: normal colon right: Irritable Bowel Syndrome (looks normal)

Question 33

Colon

Answer 33

Ulcerative Colitis: pseudopolyps isolated islands of regenerating mucosa bulge into the lumen

Question 34

Answer 34

Ulcderative Colitis: Active Colitis top left: neutrophils attacking crypts bottom left: crypt rupture (looks like granuloma but not) right: crypt abscesses

Question 35

Answer 35

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)

Question 36

Potential cause? Risk of what?

Answer 36

Toxic Megacolon: colonic dilation cause: Ulcerative Colitis risk of perforation

Question 37

What is this? What caused it? What is at arrow?

Answer 37

Acute Ulcerative Colitis (due to immunocompromised state) arrow: CMV infected cell: looks like a vessel wall; inclusions in nucleus and cytoplasm

Question 38

Why does this patient have CMV? What else might they have?

Answer 38

immunocompromised ulcerative colitis

Question 39

Colon

Answer 39

Left: Ulcerative Colitis activity Right in box: Dysplasia (architecture distortion, hyperchromasia, cigar nuclei)

Question 40

What is this? What increases the risk for this?

Answer 40

Small Bowel Obstruction air fluid lines (should not be as many or as prominent in normal patient) Crohn's disease can increase risk

Question 41

Answer 41

bottom arrow: stricture in distal ileum (narrowing) top left: ascending colon top right: small intestine

Question 42

Terminal Ileum

Answer 42

Crohn's disease arrow: ulceration

Question 43

Answer 43

Crohn's disease arrow: stricture intetinal wall is thickend and rubbery due to: transmural edema, inflammation, submucosal fibrosis, hypertrophy of muscularis propria

Question 44

Answer 44

Crohn's disease: Fissures develop btwn mucosal folds, may extend to become fistula (vaginal or perianal) or perforation (gross)

Question 45

Answer 45

Crohn's: Creeping Fat mesenteric fat extends around the serosal surface (second to extensive transmural disease)

Question 46

Answer 46

Crohn's disease crypt abscess: cluster of neutrophils in crypt

Question 47

Answer 47

Crohn's disease architectural distortion due to crypt destruction and regeneration

Question 48

Answer 48

Crohn's disease: Noncaseating granuloma histiocytes that have loosely aggregrated