免疫病理检查AE1/AE3(+ ) S-100(少+ )G_百度拇指医生
&&&普通咨询
?免疫病理检查AE1/AE3(+ ) S-100(少+ )GFAP( +)CD99( +)Ki67(少+ )
拇指医生提醒您：医生建议仅供参考。
女35岁|科室：影像检验科
德州市人民医院
你好，免疫组化的结果单独看是没有什么意义的，需要把完整的病理报告发过来看看的。
向医生提问
完善患者资料：*性别：
就是输尿管有增生，反复的炎症刺激引起的。
病理检查提示孤立性纤维瘤，多考虑良性病变的表现，建议结合临床尽早手术治疗为妥，这...
孤立性纤维瘤比较少见，一般不会出现严重的临床症状，虽然不是恶性肿瘤，但复发率较高...
你好，可以认为孤立性纤维瘤是介于良性和恶性之间的肿瘤，早期切除效果还不错，但是一...
从患者目前免疫组化的结果来看，目前多半是良性的肿瘤，建议患者需要定期复查会比较好...
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151 Cards in this Set
Cervix from prolapsed uterus
Endocervical tunnel clusters!
Benign mimic of adeno
Lobular architecture
Give the classic locations for the following cysts:
Bartholin: 4 & 8:00 introitus, mucinous
Skene: paraurethral
Gartner: lateral vag wall, simple columnar
BerEp4 & B72.3
+ in adeno, - in mesothelioma
IHC to PCP detects what forms?
Cysts AND trophs
Skin nodule
+ PAX5, CD99, chromo/synapto
+ punctate perinuclear CK20
Merkel cell carcinoma
another name for AMACR
p504s + in prostatic neoplasms
+ CK, p63, 34betaE12, Cam5.2 lesional cells
+ CD3, CD1a, TdT, CD99 lymphs
What if also CD5 & ckit+?
CD5 & ckit are markers for thymic carcinoma
variations?
Chromophobe CK7+, PAX2-
Papillary RCC CK7+
Primary HCC stains how:
CK7, CK20, AE1/AE3, Cam5.2, pCEA, HepPar1
How is fibrolamellar variant different?
focal AE1/AE3
pCEA + canalicular
(fibrolamellar variant is CK7+)
Phenotype of PEComas?
tyrosinase
tyrosinase + (50%)
What are the limitations of using AEC (3-amino-9-ehtyl carbazole) as a chromogen?
It is alcohol soluble and must have an aqueous medium for cover slipping.
DAB (diaminobenzidine) is preferred, it is alcohol insoluble and forms a brown pigment, but is more carcinogenic.
Most sensitive IHC in MPNST?
Collagen IV
IHC nephrogenic adenoma
AMACR, PAX2
Patient population and tumor type of lung cancers with activating EGFR mutations
Non-smoker
Adenocarcinoma
prognostic groups in neuroblastoma
Hyperdiploidy, no structural chromosomal abnormalities, expression of Trka neurotrophin receptor
Unfavorable:
Diploid, -1p, -11q, +17q, MYCN amplification
Kids & 1 better px unless MYCN amplification
gene fusion see in what 2 tumors?
Alveolar soft part sarcoma
Xp11.2 renal cortical tumors
Genes involved in alveolar RMS?
high risk subgroup
Favorable group
can be amplified as double minutes
name the cardiomyopathy:
1. dilation of all 4 chambers
2. Hypertrophic septum
3. Thin RV replaced by fat
4. bilateral dilation of atria
1. dilated CM
- large, flabby heart, viral/EtOH/pp/drug
2. hypertrophic CM
- haphaza loose ground substance
3. Arrhythmogenic RV dysplasia
- young familial
4. Restrictive CM
- #1 ww: endomyocardial fibrosis (kids, tropics)
- US: amyloid, hemochromatosis
2 syndromes with cardiac myxomas
Carney syndrome
cardiac section
aschoff nodule
Anitschkow cell: caterpillar nucleus!
Libman sacks endocarditis
BOTH sides of valve
fibrinoid necrosis with lots of POLYS
DDx eos in the heart
Diseases that recur after cardiac transplant
giant cell myocarditis
Best stain for cardiac myxoma vs sarcoma?
calretinin (+ in myxoma)
ignore the glands. what is the name for these bodies, and where are they seen?
Gamma Gandy bodies
formed by calcific elastic fiber degeneration with hemosiderosis
Seen in atrial myxomas, and spleen, associated with cardiac congestion and sickle cell anemia.
What cardiac tumor is associated with extramedullary hematopoiesis?
myxoma, 10%
most sensitive marker for angiosarc
small vessel vasculitides
Churg Strauss
Cutaneous leukocytoclastic vasculitis
name the classic association in these medium-vessel vasculitides
Giant cell arteritis
Polyarteritis nodosa
Thromboangiitis obliterans
Giant cell arteritis - polymyalgia rheumatica
Polyarteritis nodosa - HBV
Thromboangiitis obliterans - smoking
Takayasu - aortic root dilation
Which vasculitis is treated with IV Ig?
Kawasaki disease is an inflammatory disease of the large, medium, and small arteries and affects children younger than 4 years of age. The major risk is the development of coronary artery aneurysm formation with subsequent rupture or thrombosis and possible sudden death. Intravenous gamma globulin is the treatment of choice for preventing coronary artery aneurysm formation and is used in conjunction with aspirin.
Most common primary cardiac sarcoma?
cardiac sarcoma most likely to involve valve?
A Right atrium, p53 mutation
KRAS mutation
#1 cause of pulmonary-renal syndrome?
ANCA disease (55%)
(anti-GBM disease 5%
What drug classically shows hepatocellular necrosis with inflammation? Antidote?
Acetaminophen
N-acetylcysteine
Name the gene:
Cholangiocarcinoma
Liver cell adenoma
Alagille: syndromic paucity of intrahepatic bile ducts
Cholangioca: Kras, c-myc
LCA: Hepatocyte nuclear factor-1alpha HNF-1a
Alagille: Jagged-1
Victoria blue or orcein of liver
Excess copper in liver cells:
Wilson's disease
Chronic biliary diseases such as PSC, late state PBC
What are Mallory bodies composed of?
constitutively ubiquitinated CK8 and CK18
can be seen in ASH, NASH, Wilson's....
Copper overload in Wilson's induces a constituent of Mallory bodies, p62, which is an adaptor protein involved in cell rescue from oxidative stress.
What liver cell makes fibrosis
stellate cell, aka Ito cell, lipocyte
Major vitamin A located in space of disse.
Transform to activated myofibroblast cells that make collagen, and then they stain for SMA
Megamitochondria are seen in?
alcoholic and nonalcoholic fatty liver disease
what condition has string of beads on radiology and has 10% risk of cholangiocarcinoma?
Associated with what antibody test?
name 2 syndromes that can have pancreatoblastoma
Beckwith Wiedemann
Ranson criteria at presentation
Age, WBC, glucose, LDH, AST
hct, BUN, Ca, base deficit, edema, O2 sat
what forms of PCP can be seen on slides?
virulence?
Cysts - classically
Can see trophs on Diff-Quik with oil immersion
Trops attach to type 1 pneumocytes
What cell type covers most of the surface area of the lung?
What cell type can replicate in lung injury?
What cell type makes surfactant and therefore has lamellar bodies on EM?
Type 1 pneumocytes cover 97% surface area of the lung, though they are less in number overall
Type 2 pneumocytes are rounded and larger, and can replicate into Type 1 pneumocytes. They make up 60% alveolar cells. Type 2 secretes surfactant, and has lamellar bodies on EM. MUC1 stains Type 2.
Associations with avascular necrosis
long term steroid use
deep sea diving
hemoglobinopathies
cytokeratins expressed in synovial sarcoma?
adamantinoma?
What GYN tumor is associated with enchondromatosis?
Juvenile granulosa cell
Vulvar lesion
+ vimentin, desmin, ER, PR, CD34
Angiomyofibroblastoma
Tumor cells are concentrated around vessels
Mast cells common
10cm vulvar lesion
+SMA, ER, PR, CD34. desmin
Aggressive angiomyxoma
Stellate cells, loose matrix, prominent vasculature
what cytokine is responsible for causing pulmonary fibrosis?
muscle biopsy
Polymyositis
ENDOMYSIAL inflammation with CD8+ Tcells
muscle biopsy
what to worry about?
Dermatomyositis
PERIMYSIAL inflammation with CD4+ Tcells
also has perfascicular atrophy
40% associated with paraneoplastic syndrome!
muscle biopsy
inclusion body myositis
~ polymyositis in many ways
Major difference between myositis and muscular dystrophies?
In muscular dystrophy, inflammation is associated with NECROTIC FIBERS
Muscle biopsy
Duchenne Muscular Dystrophy
Endo & perimysial fibrosis
Atrophy & hypertrophy = size var
Necrotic fibers
“Hyaline fibers”: large, dark, glassy
Increased internal nuc
8) Microinvasive breast carcinoma
A. is defined as invasive carcinoma with no focus measuring greater than 1.0 mm.
B. is reported as sum of the sizes when multiple foci are present.
C. is defined as invasive carcinoma with no focus greater than 1.0 cm.
D. is usually low grade.
E. is usually not encountered in the setting of ductal carcinoma in situ (DCIS).
A) is defined as invasive carcinoma with no focus measuring greater than 1.0 mm.
Which of the following is considered a positive HER2 result for invasive breast carcinoma?
A. Uniform intense membrane staining in &10% of invasive tumor cells by immunohistochemistry
B. Uniform intense membrane staining in &50% of invasive tumor cells by immunohistochemistry
C. Ratio of HER2 to CEP17 & 1.8 by FISH
D. Ratio of HER2 to CEP17 & 2.2 by FISH
E. HER2 gene copy number greater than 4 signals/nucleus by FISH for tests without an internal control probe
D. Ratio of HER2 to CEP17 & 2.2 by FISH
According to the most recent American Society of Clinical Oncology/CAP guidelines, HER2 results are defined as follows:
+ = By IHC, 3+ staining (uniform intense membrane staining in & 30% of invasive tumor cells) ; by FISH, HER2:CEP17 & 2.2 or
HER2 gene copy # & 6 signals/nucleus for tests w/out an internal control probe.
Equivocal = By IHC, 2+ staining (weak to moderate complete membrane staining in & 10% of invasive tumor cells); by FISH, HER2:CEP17 of 1.8-2.2 or
HER2 gene copy # 4-6 signals/nucleus for tests w/out an internal control probe.
Negative = By IHC, 0-1+ staining (no staining to barely perceptible incomplete membrane staining); by FISH, HER2:CEP17 of & 1.8 or
HER2 gene copy # & 4 signals/nucleus for tests without an internal control probe.
17) A 63-year-old Caucasian woman is found to have a pigmented scaly nipple lesion, intermittent bloody discharge, and a clinically palpable breast mass. What immunostains is most likely to be +?
Diff dx of pale, clear cells in the nipple includes Paget's cells, changes due to inflammatory skin conditions, changes associated w/ mammary ductal ectasia, as well as various tumors (Bowen's disease, basal cell carcinoma, & melanoma). W/ the clinical presentation of a breast mass, the skin lesion most likely represents Paget disease of the breast. Paget cells are + for HER2 and show high MIB-1 expression.
Which of the following entities occurs with the lowest frequency in adolescents?
A. Papillomatosis
B. Fibroadenoma
C. Atypical duct hyperplasia
D. Secretory carcinoma
E. Papillary duct hyperplasia
Of the lesions listed, fibroadenoma is the most common dx in young females. Juvenile papillomatosis, also known as &swiss cheese disease,& typically afflicts women in their 20's. Due to hormonal changes, fibrocystic changes in the form of papillary duct hyperplasia can also affect young female breasts. Although the incidence of breast
carcinoma in adolescents is & 0.1%, secretory carcinoma is known to arise in adolescents. In contrast, ADH is an extremely rare finding in young
Which of the following is true with regard to the neoplasm illustrated in the images?
A. Absence of MUC-1 expression is a typical feature.
B. It is characteristically ER, PR, & Her2/neu negative (&triple negative&).
C. It has an excellent px, w/ 10 year survival & 90%.
D. It displays a higher incidence of lymph node metastasis compared to typical IDC.
E. The growth pattern is not characteristic of a primary breast tumor and indicates a metastatic neoplasm.
D) It displays a higher incidence of lymph node metastasis compared to typical IDC.
Invasive micropapillary ca of the breast, characterized by pseudopapillary or tubuloalveolar nests of tumor cells present w/in clear, empty spaces. The tumor cells have been described as having an &inside out& growth pattern, w/ microvilli present along the outer aspect of the tumor clusters, abutting the space surrounding the tumor rather than w/in a central lumen. This growth characteristic is further supported by the pattern of MUC-1 expression. This glycoprotein typically is found along the luminal surface of usual ductal carcinoma, but it is expressed along the outer aspect of the tumor nests of invasive micropapillary ca, again abutting the empty spaces containing tumor cells. ER, PR & HER2/neu expression is variable. Invasive micropapillary ca is an aggressive variant of breast ca w/ a higher incidence of LN metastasis compared to typical IDC. The diff dx includes mucinous ca of the breast & metastatic serous ca from the ovary. The presence of mucin in the former and expression of WT1 in the latter help to make the distinction from invasive micropapillary ca.
Which of the following statements is true with regard to solid papillary carcinoma?
A. Myoepithelial cells surround the periphery of these neoplasms, as in other forms of in situ ca.
B. The neoplastic cells strongly express HMW CKs such as CK5/6.
C. This neoplasm typically occurs in younger women, & 50 years of age.
D. The tumor cells may exhibit neuroendocrine features, highlighted by expression of synaptophysin and chromogranin.
E. Invasive medullary ca often occurs in assoc w/ solid papillary carcinoma.
D) may exhibit neuroendocrine features, expression of synaptophysin and chromogranin.
SPC occurs in older women 60-80 yrs.
Circumscribed, solid nests of neoplastic epithelium with not-readily-apparent presence of fibrovascular cores.
SPC thought to be variant of DCIS.
Spindled, streaming appearance of cells may mimic UDH, but SPC lacks CK5/6+. Mucinous carcinoma is a pattern of frankly invasive carcinoma often assoc w/ SPC,
The attached image shows a section of pancreas from a 5-year-old girl whose hospital course was complicated by abdominal pain and poor glucose control.
What is the process shown in the image?
The image shows a focal acute inflammatory infiltrate centered on, and compromising, a pancreatic islet.
The pancreatic acini and ducts are uninvolved and there is no evidence of necrosis, hemorrhage, or interstitial inflammatory infiltrate.
Taken together these findings are indicative of insulitis, an infiltration of the pancreatic islets, usually by T lymphocytes.
While not commonly seen, insulitis is associated with type 1 diabetes mellitus and the infiltrate may be focal and unevenly distributed.
Acute and chronic pancreatitis may eventually involve the islets but one would expect to see pathology also involving the acini.
Similarly, with chronic rejection one often sees fibrous replacement of the acini and septa with fibrosis.
Cystic fibrosis is characterized by parenchymal fibrosis and dilated ducts with inspissated secretions.
The hemorrhage depicted in the photograph is most likely due to?
The image depicts an intracerebral hemorrhage that has eroded into and begun to fill the lateral ventricles.
The most common cause of a hemorrhage is due to hypertensive damage to blood vessels.
Though vascular malformations and central nervous system tumors can also cause intracerebral hemorrhage, hypertension is far more common.
Blunt force injuries to the head more commonly produce accumulations of blood in the subdural or subarachnoid spaces and vertebral artery lacerations produce accumulations of subarachnoid hemorrhage around the base of the brain.
In a non-forensic (hospital) autopsy, the College of American Pathology recommends that paraffin blocks be retained for what period of time after the final report is issued?
When reviewing a consent for an autopsy you are about to perform you note that the family has requested that you obtain a sample of the decedent's DNA during the autopsy with the intent of performing paternity testing at a later date.
What is the best specimen and collection device for this DNA sample?
A) Serum- tiger top tube
B) Vitreous fluid- red top tube
C) Whole blood- grey top tube
D) Whole blood- red top tube
E) Whole blood- filter paper
E) whole blood-filter paper
You are asked to perform an autopsy on a 56-year-old man who presented to the hospital 3 days ago with mild distress and left forearm pain which progressed to fulminant sepsis and necrotizing fascitis with subsequent amputation of the left arm.
The patient was placed on broad spectrum antibiotics but his condition continued to deteriorate before care was withdrawn.
A chart review prior to autopsy reveals antemortem blood cultures and tissue cultures from the amputation specimen are positive for Clostridium septicum.
Given this information, which of the following procedures would be most important at autopsy?
A) Collect postmortem bacterial blood cultures
B) Collect bacterial tissue cultures from the amputation base
C) Inspect the entire mucosal surface of the intestines
D) Inspect the entire skin surface for evidence of prior injury
E) Perform the autopsy in a biosafety level 3 facility
C) Inspect the entire mucosal surface of the intestines
Necrotizing fascitis due to Clostridium septicum is somewhat unique in that pts often do not have any evidence of trauma to suggest a pt of entry for the bacteria, rather often this infexn is seeded hematogenously from the intestines where these pts have a high rate of colorectal carcinomas and other diseases which predispose them to infexn.
For, this reason it is imperative to examine the entire mucosal surface of the intestine to identify an underlying cause for the infxn.
A 59-year-old man underwent subcranial resection of a large skull base tumor.
Based on the provided image from the resected specimen, which stain would be most helpful in the distinguishing this lesion from a chondrosarcoma?
+ expression in &90% of chordomas including dedifferentiated and chondroid chordomas.
A 15-year-old girl presents with pain and swelling around the right knee following a soccer injury.
Imaging studies revealed a lytic expansile lesion of the proximal tibia with internal septa and fluid-fluid levels.
Based on the provided images, what is the most likely molecular genetic abnormality?
t(16;17) CDH11:USP6 fusion
aneurysmal bone cyst
A 59-year-old man underwent excision of a 4-cm soft tissue mass involving the lower neck.
Based on the provided images, what chromosomal abnormalities are associated with this tumor?
spindle cell/pleomorphic lipomas typically have abnormalities of 13q14-22
A 15-yo boy developed pain, swelling and stiffness around the left knee following a baseball injury.
Imaging studies revealed a lytic lesion involving the proximal left tibia.
Based on the provided image, what is the best dx?
Chondroblastoma is an uncommon primary bone tumor that most often occurs at the epiphyseal end of long bones in skeletally immature individuals.
A 35-year-old man developed slowly progressive abdominal swelling with intermittent pain. Imaging studies revealed multiple serosal nodules which led to image guided biopsy of one.
Based on the provided hematoxylin and eosin (H&E) image from the biopsy and the fact that a t(11;22)(p13;q12) was identified what is the most likely immunophenotype?
Desmoplastic round small cell tumor (DSRCT) is an aggressive small round cell sarcoma most often occurring in young men, abdominal cavity.
Most have a recurring t(11;22)(p13;q12) EWS-WT1 fusion. &90% + vimentin, CK, EMA, desmin, WT1.
Desmin: dot-like perinuclear reactivity
Which of the following genetic abnormalities, when occurring in radiation-associated angiosarcoma, best distinguishes them from radiation-associated atypical vascular lesions?
A) p16 mutation
B) MDM2 amplification
C) MYC amplification
D) p53 mutation
E) EWS mutation
C) MYC amplication 8q24
Which of the following immunohistochemical stains is most useful in positively identifying low-grade fibromyxoid sarcoma and differentiating it from its mimics?
A) S100 protein
E) Beta-catenin
LGFMS t(7;16) FUS/CREB3L2
A 55-year-old man underwent needle core biopsy of a large retroperitoneal mass with both solid and fatty components on imaging.
Based on the image provided, what would be the most likely genetic alteration?
Dedifferentiated liposarcoma
MDM2 amplification chromosome 12q
A 20-year-old man presents with a nodule of the distal upper extremity with the histologic features seen in the top panel.
The lower panel shows an immunohistochemical stain demonstrating loss of nuclear expression within tumor cells.
Which immunohistochemical stain is represented in the lower panel?
Epithelioid sarcoma.
The bottom panel shows loss of INI-1 expression in tumor cells, w/ retention of nuclear INI-1 seen in endothelial and inflammatory cells.
INI-1 is the product of the hSNF5/INI-1/SMARCB-1/BAF47 gene.
INI-1 is a tumor suppressor involved in ATP-dependent chromatin remodeling, cell cycle control and regulation of the cytoskeleton.
Loss of nuclear INI-1 expression is the hallmark of pediatric rhabdoid tumors & atypical teratoid/rhabdoid tumors of the CNS.
Loss of INI-1 expression is seen in &90% of epithelioid sarcomas, but expression is intact in normal tissues and almost all other sarcomas & carcinomas.
A 55-year-old woman underwent resection of a painless 5-cm thigh mass, which had been present for many years.
Based on the provided images, what is the most likely genetic alteration in this neoplasm?
Chondroid lipoma, a rare benign adipose tissue tumor, may histologically resemble myxoid liposarcoma or extraskeletal myxoid chondrosarcoma, but is genetically distinct.
In a study by Huang et al, an identical reciprocal translocation, t(11;16)(q13;p13), was identified in three chondroid lipomas, a finding consistent with previously isolated reports.
A FISH-based positional cloning strategy using a series of BAC probe combinations revealed MKL2 as the candidate gene. Subsequent 5' RACE studies demonstrated C11orf95 as the MKL2 fusion gene partner.
MDM2 amplification is seen in well-differentiated liposarcoma. t(12;16)(q13;p11) is seen in myxoid liposarcoma and t(9;22)(q22;q12) is seen in extraskeletal myxoid chondrosarcoma while t(12;22)(q13;q12) is seen in clear cell sarcoma of soft tissue (among other tumor types as well).
Which of the following is true regarding alveolar rhabdomyosarcoma?
A) More favorable prognosis than embryonal rhabdomyosarcoma
B) Majority have a t(1;13)
C) Type of gene fusion is not prognostic
D) Most common location is the paranasal sinuses
E) Myogenin stains a majority of nuclei compared to embryonal rhabdomyosarcoma
E) Compared to embryonal rhabdomyosarcoma, myogenin typically stains a majority of tumor nuclei whereas in embryonal rhabdomyosarcoma only a small subset of tumor nuclei are positive.
Most have a t(2;13) resulting in PAX3-FKHR fusion. This more common translocation is associated with a less favorable prx compared to the t(1;13) which results in a PAX7-FKHR fusion. Most alveolar rhabdomyosarcomas occur in the extremities and these have a worse prx than embryonal rhabdomyosarcoma.
The immunohistochemical profile of clear cell sarcoma includes which of the following?
A) Immunoreactivity for melanocytic markers
B) Nuclear FLI-1 immunoreactivity
C) Loss of INI-1 immunoreactivity
D) Nuclear reactivity for TLE-1
E) Immunoreactivity for myogenic markers
A) immunoreactivity for melanocytic markers
An 11-year-old boy underwent excision of a slowly growing, painless soft tissue wrist mass.
Based on the provided images, what is the best dx?
calcifying aponeurotic fibroma
comprised of nodular calcific deposits surrounded by a palisade of chondroid-type cells & associated w/ a bland spindled fibroblastic component between the nodules.
A newborn boy was noted to have a 1.5-cm swelling located in the subcutis of the posterior shoulder region.
Based on the provided images, what is the best diagnosis?
fibrous hamartoma of infancy
triad of intersecting trabeculae of dense collagenous tissue with fibroblasts, islands of primitive mesenchymal tissue and interspersed mature adipose tissue
A 33-year-old woman suffered a pathologic fracture of the right proximal humerus following a fall.
Imaging revealed a fracture through a lytic lesion involving the epiphysis and metaphysis of the right proximal humerus.
Based on the provided images, what is the best potential target for non-surgical therapy for this tumor?
Discoveries indicate that RANK-ligand plays an import role in the pathogenesis of giant cell tumor of bone, especially in recruiting and activating osteoclasts, and preliminary studies have shown anti-RANK-ligand therapy (Denosumab) to have clinical activity in unresectable and metastatic disease.
A 57-year-old woman underwent resection of a large pleural based mass replacing most of the left thoracic cavity.
Based on the images provided, what paraneoplastic syndrome is most likely to be associated with this neoplasm?
Solitary fibrous tumor associated with hypoglycemia secondary to produxn of insulin-like growth factor.
Occurs in 4% of tumors.
Doege-Potter syndrome
A 12-year-old boy presented with slowly progressive painful thoracic scoliosis.
Computed tomography (CT) scan disclosed a 3.1-cm expansile, well-demarcated, mixed lytic and sclerotic bone tumor involving the T-7 vertebrae.
Based on the images provided, where is this tumor usually located?
Osteoblastomas classically involve the dorsal elements of the spine (about half of cases).
When they occur in long bones, most arise in the diaphysis or metaphysis but some are epiphyseal.
Although benign, about 20% recur and, unlike osteoid osteomas, the pain is not relieved by aspirin.
A 67-year-old woman excision of a painless 8-cm soft tissue mass involving the right buttock.
Based on the provided images, which gene is most likely altered?
Intramuscular myxomas frequently have point mutation of the GNAS1 gene.
This includes both syndromic (McCune-Albright, Mazabraud) and non-syndromic lesions.
GNAS1 encodes for the alpha-subunit of the G-protein that result in cAMP formation.
A 25-year-old woman needle core biopsy of an 11-cm posterior thigh soft tissue mass.
Based on the provided image, what immunohistochemical stain would be most specific in confirming the diagnosis?
Alveolar soft part sarcoma
t(X;17)(p11;q25)
TFE3 gene on chromosome Xp11
A 13-year-old boy developed pain and swelling around the left knee which led to identification of a proximal tibia mass. The mass was biopsied.
Based on the provided image from the biopsy, which of the following histologic features is most predictive of survival in this patient?
&90% necrosis following neoadjuvant tx
Osteoblastic osteosarcoma txed by neoadjuvant chemotx followed by definitive surgical resection. Response to chemotx, as judged by % tumor necrosis, is the single most sensitive histologic indicator of survival in conventional osteosarcomas.
What is the most common fusion gene found in angiomatoid fibrous histiocytoma?
EWSR1-CREB1
These images are representative of a R-sided colon ca from a 65-yo female smoker w/ no family hx of colorectal ca.
The IHC stain depicted is MLH-1.
What is the most likely molecular phenotype of this ca?
A) CpG island methylator phenotype high, MSI high, BRAF mutation
B) CpG island methylator phenotype negative, MSI high, no BRAF mutation
C) CpG island methylator phenotype high, MSI stable, variable BRAF mutation
D) CpG island methylator phenotype negative, MSI stable/low, variable BRAF and KRAS mutations
E) CpG island methylator low, MSI stable, and KRAS mutation
A) CpG island methylator phenotype high, MSI high, BRAF mutation
Histologic features of MSI high tumor: R-sided colon ca, medullary phenotype, increased intraepithelial lymphs, Crohn's-like inflmmxn.
Given pt age, absence of family hx of cancers and loss of MLH-1 this colon ca most likely is sporadic MSI high colorectal ca.
Sporadic MSI-H tumors occur due to hypermethylation of CpG promoter region in MLH-1 gene.
BRAF mutations do not generally occur in Lynch syndrome associated ca.
KRAS mutation testing is done to guide tx options in pts w/ metastatic colon cancers.
This bx was obtained from the small bowel of an otherwise healthy 75-yo woman at the time of surveillance for Barrett's esophagus.
On further evaluation, the pt lacked other lesions.
The immunostain depicted in the 2nd picture is a BCL-2 preparation. Which statement best describes the clinicopathologic findings?
A) This T cell lymphoma would be expected to behave aggressively.
B) When involvement by follicular lymphoma is restricted to the small intestinal mucosa, the patient can be managed by observation since such lymphomas are indolent.
C) The clinicopathologic features are most in keeping with extranodal marginal zone lymphoma.
D) This MCL will require aggressive treatment.
E) In all likelihood, this patient with so-called &IPSID& (immunoproliferative small intestinal disease) is from the Middle East.
B) When involvement by follicular lymphoma is restricted to the small intestinal mucosa, the pt can be managed by observation since such lymphomas are indolent.
Although BCL-2 is generally a non-specific stain, its diffuse immunoreactivity in this case, along with the histologic features, assists in excluding a reactive follicular hyperplasia. Primary intestinal follicular lymphomas behave indolently if the disease is truly restricted to the small bowel.
A 48-yo woman undergoes upper GI endoscopy for w/u of heartburn.
Endoscopy reveals a firm yellow-white esophageal submucosal nodule.
A bx from this area is represented on the provided histologic image, w/ the right lower corner image representing a HPF of the lesional cells.
Which of the following IHC stains would you expect to be strongly + in the lesional cells?
A) Synaptophysin
B) CD117(c-kit)
C) Smooth muscle actin (SMA)
E) Cytokeratin AE1/AE3
Granular cell tumors (GCT) are of Schwann cell origin & therefore strongly + for S100.
Although most common in the skin & tongue, when found in the GI tract, the esophagus is the most common location.
The provided image highlights the classic appearance: sheets of epithelioid & elongated bland cells w/ abundant granular eosinophilic cytoplasm & dark, pyknotic nuclei.
For unknown reasons, the squamous epithelium that overlies GCTs often develops pseudoepitheliomatous hyperplasia which can mimic a squamous cell carcinoma.
A 13-yo boy presents w/ chronic diarrhea & joint pain.
A clinical dx of celiac disease is strongly considered.
In this pt, what histological feature(s) in a duodenal bx would be most sensitive, but not most specific, to support the dx of celiac sprue, in the appropriate clinical & serological setting?
A) Heavy lymphoplasmacytic infiltrate of lamina propria.
B) Villous blunting & increased mast cells in the duodenum.
C) Increased intraepithelial lymphocytosis.
D) Intraepithelial lymphocytosis and crypt apoptosis.
E) Villous blunting with reduced lamina propria plasma cells.
C) increased intraepithelial lymphocytosis
Increased enterocyte lymphocytosis is the most sensitive histological feature for a dx of celiac disease.
This lymphocytosis tends to occur at the tips of the duodenal villi. The cut-off for normal duodenal intraepithelial lymphocytes (IELs) varies, however, current literature documents the upper limit of normal for duodenal IELs to be 25 IELs per 100 epithelial cells (mean + 2 SD).
Villous blunting is seen in celiac sprue and is more specific than lymphocytosis alone, but it is not the most sensitive indicator.
A 45-yo pt undergoes resexn of a small bowel mass, sxns of which are shown in the images below.
The tumor is diffusely + for S100 & negative for keratin, SMA, desmin, and CD117.
What translocation does this tumor most likely have and how does the tumor most likely stain for melanin related markers by IHC?
t(2;22)(q32;q12) ESWR1-CREB1, Melan A-, HMB45-
Clear cell sarcoma of the GI tract
In contrast, clear cell sarcomas of LEs of young adults have t(12;22)(q13;q12) EWSR1-ATF1, Melan A+, HMB45+, S100+.
A 36-yo woman on OCPs & no underlying liver disease presents to the ED w/ an acute abdomen. Ex-lap reveals blood in the peritoneal cavity in assoc w/ a hemorrhagic liver lesion. A partial liver resexn is performed w/ the following gross image available for your review.
What is the most likely dx?
Hepatocellular adenoma with rupture
associated with Hepatocyte nuclear factor-1a
A 43-yoman with a strong family hx of colorectal & endometrial cancers presents w/ colonic ca. A sexn from the colon mass along w/ immunostains for MSH2 & MSH6 are provided for your review.
What is the likely molecular phenotype of this ca?
A) CpG-island methylator phenotype high, microsatellite instability (MSI high), BRAF mutation
B) CpG-island methylator phenotype negative, MSI high, no BRAF mutation
C) CpG-island methylator phenotype high, microsatellite stable (MSS), variable BRAF mutation
D) CpG-island methylator phenotype negative, MSS, variable BRAF and KRAS mutation
E) CpG-island methylator phenotype negative, MSS, and KRAS mutation
B) CpG-island methylator phenotype negative, MSI high, no BRAF mutation
Absence of MSH-2 & MSH-6 (loss of nuclear staining seen in the additional images), indicate a Lynch syndrome/HNPCC-associated carcinoma.
A 61-yo man undergoes upper GI endoscopy for sxs assoc w/ gastroesophageal reflux disease (GERD).
The provided endoscopic image from the duodenal bulb shows an area of nodular mucosa.
A histologic image from a bx of this area is also provided for review.
Which of the following is true?
A) This finding is directly related to the patient’s hx of GERD.
B) The histologic features of this bx represent a normal transitional change from the pylorus to the duodenum.
C) This finding most likely led to the patient’s symptom of epigastric pain.
D) The presence of both surface gastric foveolar as well as oxyntic glands distinguishes this dx from gastric foveolar metaplasia.
E) This finding is associated with Peutz-Jeghers syndrome.
D) The presence of both surface gastric foveolar as well as oxyntic glands distinguishes this dx from gastric foveolar metaplasia.
Congenital heterotopic gastric mucosa (gastric heterotopia) is a common finding in the duodenal bulb.
Its presence is usually asymptomatic and therefore found incidentally.
The most common appearance by endoscopy is that of a single nodule or multiple polypoid nodules.
Therefore these bx may be labeled by the endoscopist as “duodenal nodule” or even “duodenal mass.”
Congenital gastric heterotopia contains all three elements of gastric mucosa (surface epithelium, gastric pits and glands- usually oxyntic type).
In contrast, gastric foveolar cell metaplasia, which develops in response to long-standing inflammxn, is characterized by surface foveolar metaplasia only.
A pt presents w/ numerous polyps in the small bowel, colon, and stomach, a representative of which is shown on the image.
What gene is most likely affected in the syndrome characterized by these polyps?
LKB1/STK11 gene in Peutz-Jeghers syndrome
A 78-yo afebrile man presents to the ED w/ bloody diarrhea & severe abdominal pain.
He states that he recently attended a family barbeque where he ate several undercooked hamburgers.
Given this hx, a stool cx using Sorbitol MacConkey agar was ordered, which the clinician tells you was + for enterohemorrhagic E. coli.
A representative histologic sexn from the right colon is submitted for your review.
Which of the following is true regarding this pathogen and its histologic features?
A) Routine stool cultures will detect the enterohemorrhagic E. coli strain.
B) This biopsy is best described as a pseudomembranous colitis pattern of injury.
C) Differentiating enterohemorrhagic E. coli from ischemic colitis is generally quite easy.
D) The most common strain of enterohemorrhagic E. coli is O137:D7.
E) Enterohemorrhagic colitis causes epithelial injury but NOT endothelial injury.
B) This biopsy is best described as a pseudomembranous colitis pattern of injury.
A 60-yo woman w/ a hx of SLE presents wx a 3-wk hx of fatigue.
Labs revealed a hb of 7.4 gm/dL.
The patient’s stool is + for blood.
The pt received 2 units of pRBCs and undergoes an EGD which revealed hyperemic streaks radiating from the pylorus alternating with normal-appearing antral mucosa.
Histology shows ectatic vessels, fibromuscular hyperplasia and vascular microthrombi.
Which of the following statements best supports this entity?
A) The endoscopic description of this entity is described as having a &snakeskin& appearance.
B) Liver disease can be found in up to 60% of these patients.
C) This entity is associated with Helicobacter pylori
D) The presence of microthrombi is the most helpful feature in making the dx.
E) It responds to therapeutic measures aimed at reducing portal pressures.
D) The presence of microthrombi is the most helpful feature in making the dx.
Gastric antral vascular ectasia (GAVE) is a rare cause of recurrent gastric bleeding which can result in transfusion-dependent iron deficiency anemia.
CD61 can help highlight microthrombi particularly in small gastric biopsies.
Which of the following situations is not associated with increased numbers of eosinophils in the lamina propria of the stomach?
A) Following eradication tx for H. pylori
B) Reactive gastropathy secondary to a drug
C) Anisakis larval infection
D) Crohn's disease
E) Portal hypertensive gastropathy
E) Portal hypertensive gastropathy
is associated with lamina propria capillary dilatation
A 43-yo HIV+ man undergoes a cholecystectomy after presenting to the ED w/severe right upper quadrant pain.
Clinical hx reveals that the pt stopped taking his antiretroviral medication 3 months prior & has suffered diarrhea, nausea and wt loss over a 2 month period.
A represented histologic slide from the cholecystectomy specimen is submitted for your review with high power special stain (PAS) in right-hand corner.
Which of the following is true regarding this parasitic infection?
A) This organism would stain positively with a mucicarmine stain.
B) This is the most common cause of AIDS-related infection of the gallbladder and extra-hepatic ducts.
C) Only immunocompromised patients can be infected with this organism.
D) This organism typically invades the surface epithelium causing an ulcerating inflammatory response.
E) The oocysts of this organism are typically large, measuring 15-20 um.
B) This is the most common cause of AIDS-related infection of the gallbladder and extra-hepatic ducts.
Cryptosporidium, a coccidial organism, attaches (but does not invade) the apical membranes of enterocytes and therefore generally elicits a mild to moderate inflammatory cell response w/out ulceration.
Cryptosporidium is PAS+ but mucicarmine negative.
The image provided is from the esophagus of a 30-yo man who c/o difficulty swallowing solid foods.
Which one of the following statements is correct regarding the entity depicted?
A) This entity affects primarily adults and only rare cases have been reported in children.
B) Rings, furrows, plaques and strictures are uncommon findings.
C) An elimination diet significantly improves sxs & reduces both endoscopic & histopathologic features.
D) A threshold of 5 eosinophils /HPF (400x) is required for diagnosis.
E) This is an immune disorder triggered by the gliadin component of gluten in predisposed individuals.
C) An elimination diet significantly improves sxs & reduces both endoscopic & histopathologic features.
Adaptive T-cell immunity driven by type 2 T-helper (Th2) cells, involving IL-13, IL-5, and IL-15 expression appears to play a major role in the pathogenesis of eosinophilic esophagitis.
There is a strong association of eosinophilic esophagitis w/ allergic conditions such as food allergies, environmental allergies, asthma, and atopic dermatitis. Histologically, a threshold of 15 eos/HPF (400x) is generally req'd for the dx, but the findings can be patchy and overlap with reflux esophagitis.
The image provided is from the stomach of a 54-yo man who presented with a 3-month hx of heartburn, bloating and nausea.
Which one of the following statements best supports this entity?
A) Approximately ~10% of the population is affected by this entity.
B) Approximately 50% of cases will develop adenocarcinoma.
C) Patients with this disease are at increased risk for T cell lymphoma.
D) Histologic findings include superficial chronic inflammation composed of lymphocytes and plasma cells as well as gastric pit neutrophilic microabscesses.
E) x is monotherapy using a PPI.
D) Histologic findings include superficial chronic inflammation composed of lymphocytes and plasma cells as well as gastric pit neutrophilic
The images provided are from an anorectal biopsy of a 50-year-old homosexual man.
Which one of the following statements is correct regarding the entity depicted?
A) Strong, diffuse, nuclear and cytoplasmic staining of p16/CDKN2A is a highly sensitive and specific marker for high-grade lesions.
B) This lesion is the result of HPV infection with serotypes 6 and/or 11.
C) Receptive anal intercourse, multiple sexual partners, and high-risk viral infection are not risk factors for this entity.
D) High-risk serotypes of HPV have been established as the pathologic factor in 15% of anal cancers.
E) Scattered p16 positive cells are present within the basal layer of normal squamous mucosa
A) Strong, diffuse, nuclear and cytoplasmic staining of p16/CDKN2A is a highly sensitive and specific marker for high-grade lesions.
The image provided is from the pancreas of a 62-year-old man who presented with jaundice, a diffusely enlarged pancreas, and hypergammaglobulinemia. What is associated with this condition?
Autoimmune pancreatitis (AIP) is a steroid responsive disease that has been extensively reported from Japan, Europe and the USA. The first type, also known as “IgG4-related pancreatitis” demonstrates classic histological features seen in systemic IgG4-related disease, such as periductal lymphoplasmacytic infiltrate, storiform periductal fibrosis, and extensive IgG4+ plasma cells by IHC. Type 1 AIP is also associated with obliterative phlebitis, elevated autoantibodies, raised serum IgG4 levels, involvement of other organs and &50% relapse rates. In contrast, type 2 AIP is associated with neutrophilic inflammation and occasional epithelioid granulomas.
Pseudocysts are not found in cases of AIP, but are frequently associated with alcoholic chronic pancreatitis.
The image provided is from the liver of a 60-yo man who c/o abdominal pain & a 20 lb unintentional wt loss over the last 6 months.
The pt was started on a PPI w/ no improvement in sxs.
Upper endoscopy was unremarkable.
Labs revealed elevated liver enzymes, with alk phos greater than twice the upper limit of the RR.
Which one of the following statements is correct regarding the entity depicted?
A) Caused by elevated levels of uric acid which crystallize and are deposited throughout the body.
B) The subtypes are distinguished by a 3-letter code.
C) The liver is the most frequently affected organ.
D) Treatment is the same irrespective of whether the disease is primary, secondary or hereditary.
E) Liver involvement is associated with a poor prx w/ a median survival of about 9 months.
E) Liver involvement is associated w/ a poor prx w/ a median survival of about 9 months.
Amyloid deposition can be focal, localized, or systemic & the deposits may be acquired or hereditary.
The systemic types are distinguished by a two-letter code that begins with an A (for amyloid).
The 2nd letter of the code stands for the protein that accumulates in the tissues and are categorized as primary (AL), secondary (AA), and hereditary (ATTR).
AL is the result of Ig light chain deposition from a population of monoclonal plasma cells. AL is not associated w/ any other diseases & conventionally requires chemotx &/or stem cell transplantation for tx. AA is associated w/ chronic inflammatory states like infection &/or arthritis.
ATTR results from deposition of the protein transthyretin (TTR) which is made in the liver. Familial amyloidosis is AD & can be treated w/ liver transplantation. In AL, the heart, kidney, spleen & peripheral nerves are the most frequently affected sites.
The liver is however it is rare to have clinical manifestations as a result of this protein deposition.
When present in the liver, amyloid can be vascular and/or sinusoidal in its distribution.
Pts w/ bx proven liver involvement (primary hepatic amyloidosis) have a poor prx w/ a median survival of about 9 months & a 5-year survival of ~10%, therefore early detection of hepatic involvement is key.
A 2-yo girl presented with a 1-month hx of abdominal distention. The pt had also had a few episodes of vomiting over the last week, but had no other symptoms.
She had no significant past medical hx.
The only significant finding on physical exam is hepatomegaly.
An MRI scan showed a solid, well-circumscribed mass measuring 10-cm in greatest dimension in the left liver.
Lab findings include normal values for CBC, LFTs, vanillylmandelic acid (VMA), homovanillic acid (HVA), and alpha-fetoprotein (AFP).
Mesenchymal hamartoma is a benign tumor of the liver that usually occurs during the first 2 years of life.
The well circumscribed lesion is often cystic with fibrous septa on imaging studies.
It can become quite large often due to cystic degeneration.
Microscopically the tumor is composed of various amounts of primitive mesenchyme and disorganized bile ducts and hepatic parenchyma.
The mesenchyme stromal commonly undergoes cystic deneneration causing a characteristic lymphangioma-like morphology illustrated in the provided image.
Rare occurrences of these lesions showing malignant transformation to undifferentiated (embryonal) sarcoma in children and adults.
The microphotograph is from the stomach of a 13-yo girl who p/w fatigue and abdominal pain.
No visible blood in stools was noted.
The endoscopist saw a nodular gastric mucosa.
This gastric tissue was negative for Congo red and the pink material in the lamina propria was highlighted in blue with a trichrome stain.
A duodenal bx tissue was normal.
Which of the following statements is true?
A) Most cases of this entity in children are associated with watery diarrhea.
B) This entity is associated with celiac disease.
C) The common feature seen in pediatric patients with this entity and patients with collagenous colitis is a history of NSAID use.
D) Patients like this present with severe iron deficiency anemia.
E) This patient is at risk of developing scleroderma.
D) Patients like this present with severe iron deficiency anemia.
Collagenous colitis
The common presentation particularly in children is that of iron deficiency anemia with sxs of fatigue and pallor due to blood loss.
This histologic section of the liver was taken during autopsy from one of multiple firm, red-brown liver masses in a 63-yo man who died rapidly of this disease.
What is the dx?
Hepatic angiosarcoma is characterized by the presence of malignant cells with endothelial differentiation lining hepatic sinusoids, with show variable degree of sinusoidal dilatation.
Which statement is true about the lesion depicted in the image?
A) This is an example of pseudomyxoma peritonei.
B) If there are cells in the mucin within the appendiceal lumen, this patient would be expected to have a poor outcome.
C) Most patients with findings such as these have synchronous ovarian neoplasms.
D) If there is peri-appendiceal extension of acellular mucin without neoplastic cells in the entirely submitted appendix, a good outcome typically ensues.
E) This patient should be tested for MLH1 germline mutations because these alterations are common in appendiceal mucinous neoplasms and the patient would be at risk for endometrial carcinoma.
D) If there is peri-appendiceal extension of acellular mucin without neoplastic cells in the entirely submitted appendix, a good outcome typically ensues.
A 55-yo woman presents to a hepatologist with complaints of severe pruritus. Her referring family practice physician told her that she had “elevated liver tests.”
Given the histologic features of the diagnostic liver bx, what clinical features are associated with this entity?
Serologic testing AMA+; increased risk of HCC= Primary biliary cirrhosis
The photomicrograph is of a tumor of the pancreas from a healthy 35-yo-woman.
Macroscopic exam revealed a well circumscribed tumor on the surface of the body of the pancreas measuring 7 cm.
It was light brown & in many areas appeared friable.
In addition to the features on the field shown, microscopically the lesion contained cells w/ foamy cytoplasm & foci of cholesterol clefts w/ foreign body type multinucleated giant cells.
IHC stains showed focal cytoplasmic stain for keratin & synaptophysin.
There was widespread nuclear positivity for both, PR & beta-catenin.
The best diagnostic possibility is?
solid-pseudopapillary tumor
Solid-pseudopapillary tumors of the pancreas affect predominantly young women and may reach large sizes before surgical removal.
The tumor may be located w/in the pancreas, but often located at the interface of the pancreas & surrounding adipose tissue.
The gross appearance may heterogeneous with solid, cystic, hemorrhagic and necrotic areas.
As shown in photo, the lower part of the field is solid whereas upper aspect shows tumor w/ discohesive aggregates of cells creating impression of pseudo- papillae.
In addition to membranous staining, beta-catenin immunoreactivity is characteristically nuclear.
Normal acinic cells have membranous staining only.
2 months post-transplant.
Acute liver rejection
3 components
Immune cell infiltrate:
T lymphs predominate, eos, few #s of plasma cells and neutrophils
Bile duct damage - global
Endotheliitis
What are the components of this process?
Autoimmune hepatitis assoc w/ ANA+
Interface hepatitis consisting of lymphoplasmacytic infiltrate w/ relative sparing of bile ducts
Emperipolesis
Hepatic rosettes: clusters of reactive hepatocytes surrounded by inflammatory cells
What are the characteristics of this disease?
Primary biliary cirrhosis
“non-suppurative cholangitis” = lymphocytic inflammation & destruction of medium-sized bile ducts w/ no hepatocyte damage or extension beyond portal tract
granulomas may or may not be present
PASD stained liver bx.
What are the characteristics of this disease process?
Serum AAT phenotype must be PiZZ, PiMZ, of PiSZ.
Normal homozygous is PiMM.
alpha-1-antitrypsin deficiency.
1 cm white nodule on capsular surface of liver.
bile duct adenoma
Benign bile ductular structures embedded w/ hyaline fibrous tissue, often w/ aggregated lymphs at its interface w/ normal liver.
Von Meyenburg complex
Dilated, irregular bile duct structures (ductal plate malformation) which may contain intraluminal bile or mucinous secretion.
What is this disease process? What are the markers for it?
Acute hepatitis, viral or drug:
ballooning degeneration with lymphocytic infiltrate
Associated with marked elevated AST and ALT.
Post-mortem section of liver most likely from a patient with ?
bile ductular cholestasis - virtually pathognomonic of sepsis.
Young person with chronically elevated alkaline phosphatase activity.
Primary sclerosing cholangitis
Associated with ulcerative colitis and increased risk of cholangiocarcinoma.
Periductal &onion skin& fibrosis.
Fibro-obliterative lesions are found only in this process.
Chronic hepatitis C
Most common cause of portal lymphoid aggregates.
These lymphoid structures resemble LNs in their architecture and cellular constituents..
What process does this represent?
What further w/u is warranted?
Hepatic venous outflow obstruction: Budd-Chiari syndrome
Marked sinusoidal dilatation and congestion and perivenular fibrosis.
Doppler US of the IVC and hepatic veins
28-yo woman taking OCPs had a liver mass detected on US.
Based on gross appearance, most likely dx?
Focal nodular hyperplasia
central, stellate scar
What is this and what is it associated with?
Microvesicular steatosis
HAART agents
Acute fatty liver of pregnancy
Reye's syndrome
Tetracylcine toxicity
Alcoholic foamy degeneration
Valproic acid toxicity
What is this and what is it associated with?
Macrovesicular steatosis
Hyperlipidemia
Metabolic syndrome
Corticosteroid tx
Describe sarcoidosis of liver histology.
Clustered portal and periportal non-necrotizing granulomas with multinucleated giant cells and fibrosis.
Prussian blue stain for iron in liver.
Multiple transfusions vs. Hereditary hemochromatosis
Transfusion-related iron deposition: Extensive Kupffer cell hemosidersosis with moderate hepatocellular iron overload.
HFE-related HH:
primary storage of iron occurs in hepatocytes with little or no Kupffer cell hemosiderin until periportal fibrosis or cirrhosis begins.
2-yo boy found to have liver mass.
Hepatoblastoma, fetal epithelial type
Hepatocytes with clear (glycogenated) and eosinophilic cytoplasm ('herringbone pattern').
Extramedullary hematopoiesis is characteristic.
Most common liver tumor of childhood and usually presents &2 yrs.
Liver bx from 5 cm diameter tumor in 56-yo man with chronic Hep C and cirrhosis.
AFP was increased.
What immunostain was used above?
polyclonal CEA for HCC
Apical (canalicular) staining pattern at the surfaces of or between adjacent tumor cells.
Acetaminophen toxicity
Marked hepatocellular necrosis in zonal, c inflammatory i residual viable hepatocytes show some steatosis.
24-yo man known to have had multiple episodes of jaundice since childhood, each resolving w/out medical tx.
LFTs were normal in between episodes.
During a recent bout of jaundice a liver bx was obtained.
Most likely dx?
Benign recurrent intrahepatic cholestasis
bile thrombi w/in bile canaliculi.
Mutation in FIC-1 (ABCB11) gene on chromosome 18
What disease?
type 1 glycogen storage disease
Glycogen storage is w/in hepatocytes which appear swollen, clear, w/ accentuated plant-like membranes.
What disease?
Niemann-Pick sphingomyelin lipidosis
Sinusoidal Kupffer cells and hepatocytes.
Chronic Hepatitis B
Grade: degree of inflammation, piecemeal or bridging necrosis
Grade 0: no / minimal inflammation
Grade 1: portal inflammation or lobular inflammation without necrosis
Grade 2: mild periportal inflammation and piecemeal necrosis or focal hepatocellular necrosis
Grade 3: moderate periportal inflammation and piecemeal necrosis or severe focal cell damage
Grade 4: severe periportal inflammation and piecemeal necrosis or bridging necrosis
Stage: degree of fibrosis
Stage 0: no fibrosis
Stage 1: enlarged fibrotic portal tracts
Stage 2: periportal fibrosis or portal to portal septa, without architectural distortion
Stage 3: bridging fibrosis with architectural distortion, no obvious cirrhosis
Stage 4: cirrhosis (probable or definite)
The region of hepatocytes that is in direct contact with the mesenchyme of portal tract is known as limiting plate (multiple arrowheads). Inflammation w/ or w/out necrosis of this region is called interface hepatitis and is a defining histopathologic feature of “activity” in chronic hepatitis. Note chronic inflammation extending focally outside the portal tract. Grade 1 interface activity.
Interface hepatitis, previously known as “piecemeal necrosis” is the extension of inflammation into the periportal hepatocyte region. Grade 2 activity
Grade 4: severe periportal inflammation and piecemeal necrosis or bridging necrosis
mutation associated with Wilson's disease?
in ATP7B gene for copper-transporting ATPase located in the trans-Golgi network of the liver result in accumulation of copper in hepatocytes.
Alagille's syndrome characterized by?
Paucity of intrahepatic bile ducts w/ various facial, vertebral, cardiac and ophthalmologic abnormalities.
Jagged-1 gene mutation
Most important pathologic feature on liver bx to establish
dx of extrahepati biliary atresia in a neonate is presence of ?
ductular reaction
Post-liver transplantation bx, diagnostic of ?
microabscesses are diagnostic of CMV hepatitis
Overlap syndromes in pt w/ liver dz refers specifically to ?
PBC or PSC that show clinical and sometimes pathologic features s/o overlap with autoimmune hepatitis
&Pipestem& fibrosis refers specifically to a lesion seen in ?
Schistosomiasis
Major hepatic change assoc w/ pre-eclampsia?
Fibrin in the portal tract vessels and periportal sinusoids.
Graft v. host disease affecting the liver typically targets ?
intrahepatic bile ducts
60-yo woman with 3 liver masses.
Muci and CK immunostains negative.
Most likely dx?
Epithelioid hemangioendothelioma
AE1/AE3 is +, but Cam5.2 is rarely +.
What tissue?
Glioma and glial tissue
TTF1 is + in what types of pulmonary carcinomas?
TTF1+ in most small cell lung carcinomas, majority of pulmonary adenocarcinomas
Negative in pulmonary SCCs
CDX2 expression:
gastric carcinomas
poorly differentiated colon carcinomas
pancreaticobiliary neoplasm
intestinal-type adenocarcinomas arising in GU tract
Barrett's epithelium
Mucinous adenoca of ovary
mucinous and large cell NE lung carcinomas
gastric carcinomas CDX2+
poorly differentiated colon carcinomas CDX2-
pancreaticobiliary neoplasm CDX2 weak or -
intestinal-type adenoca arising in GU tract CDX2+
Barrett's epithelium CDX2+
Mucinous adenoca of ovary CDX2 patchy, strong+
mucinous & large cell NE lung ca CDX2 patchy, strong+
What is the relative risk of developing invasive carcinoma with:
Proliferative cystic disease w/out atypia?
DCIS, LCIS
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