Pathology Cloud

Saleh Najjar MD, 2nd Year Surgical Pathology Resident University of Jordan Hospital Amman, Welcome to My Blog !!

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“Towards Curing Incurable Cancer” Amazing lecture by Prof. James Watson, co-discoverer of the structure of DNA, at King Faisal Specialist Hospital and Research Centre.

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Never Assume

This is a fine needle aspiration from 50 years old female patient presented with bilateral ovarian masses. She is also known case of breast carcinoma for which she had mastectomy. Hypercellular smear Monotonous nuclei. Different architectural patterns including trabecular, follicular grouping. Many nuclear grooves. The following features strongly support the diagnosis of Granulosa Cell Tumor of…

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Lung Nodule , 15 years old boy

Lung Nodule , 15 years old boy

          Case of metastatic Osteosarcoma to the lung

cellular smear composed of plasmacytoid cells

pleomorphism

osteoid matrix strands

mitosis

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Another Chromophobe RCC :-)  

Things to note :

well defined cell border

fluffy , moth-eaten cytoplasm

accentuation at the periphery

dark irregular nuclear membranes ( rasinoid)

inconspicuous nucleoli

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Renal Rhabdoid Tumor, Case of 2 Years Old Infant with Large Right Renal Mass

Renal Rhabdoid Tumor, Case of 2 Years Old Infant with Large Right Renal Mass

Renal Rhabdoid Tumor : Touch Imprints:    -Hyper cellular.    -Vesicular nuclei with reniform indented contour.    -Prominent nucleolus.    -Abundant pink cytoplasm.    - Frequent mitotic figures.    H & E Sections: INI immunostain is negative The rhabdoid tumor is an exceedingly rare renal tumor that occurs predominantly in infants and young children. The tumor is highly…

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Thigh Mass

Male patient in his second decade presents with huge thigh mass.

Touch preparations stained with…

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Langerhans Histiocytosis of the Skin

   Langerhans cell histiocytosis is primarily a disease of childhood, although it clearly also…

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Conjunctival Cystic Nevus

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ArterioVenous Malformation of the brain

Arteriovenous malformations (AVMs) are  type of vascular malformation most relevant to the…

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Adenomatoid Tumor

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This patient underwent total abdominal hysterectomy and bilateral oopherectomy  due to endometrial complex hyperplasia with atypia, the left ovary showed a  mass ” couldn’t resist the temptation of taking a smear for fast pap stain” which showed this spindle tumor with fasicular arrangement. the tumor later proved to be a fibrothecoma quit known to screte lots of estrogen that may lead to hyperplastic endometrium. strangly the cells on smears showed many grooves as on sections a feature seen in estrogen secreting  granulosa cell tumor.

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Adrenal Cyst Aspirate, A Case of Pheochromocytoma 

The smears are hyper cellular.

cells appear singly or in loose groups or pseudo rosettes.

Three types of cell have been described:

          The first type is small to moderate-sized polygonal cells with finely granular cytoplasm and uniform roundor oval nuclei with granular chromatin and prominent chromocenters. These cells are the prototypic cells of neuroendocrine tumors.

           The second type is spindle cells with abundant cytoplasm, elongated nuclei, and coarse granular chromatin.

           large, myoid-like cells with eccentric large nuclei, prominent nucleoli, and abundant pale, finely granular cytoplasm

 The smears may be composed of a mixture of these cell types or one cell type may predominate.   "M.BIBO 3rd ed"

Aspirating a pheochromocytoma is dangerous as it may precipitate a hypertensive crisis. 

Remember the rule of 10% and multiple endocrine neoplasia association.

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Follicular Neoplasm, Thyroid lesion

Hyper cellular smears

Micro follicles

Absent macrophages

little to no colloid

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Chromophobe Renal Cell Carcinoma  "ChRCC"

Hi there, few days ago i stumbled upon this relatively uncommon renal tumor and misdiagnosed it as Conventional renal cell carcinoma on smears. " seams i got so much to learn " 

So lets review the Cytological Characteristics of this tumor :

polygonal cells.

well defined borders.

granular to light transparent cytoplasm, clear cells are rare.

accentuation of the granularity at the periphery of the cell. 

central halo giving the cell koilocyte like appearance.   

the nuclei are eccentric with anisonucleosis. 

some of the nuclei are condensed with raisinoid appearance. 

Beware of the Eosinophilic Variant of Chromophobe RCC as it very hard to differentiate from  Renal Oncocytoma which is a benign tumor.

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Schwannoma, presents as Intra Abdominal mass 

 - Cohesive groups of cells with indistinct  borders. 

 -Long slender tapering nuclei sometimes bend and form hooks and comma     shapes.

 - Fibrillari back ground. 

 - Watch out from degenerative changes which including pleomorphism. 

- if you find Verocay bodies you are lucky 

 This case is dedicated to our dear colleague and friend Ahmed AboSolb, leaving us soon. your case is solved from the very first day  :-)

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  Ovarian cyst form 40 years old lady. it was 18 C.M in diameter, unilocular and filled with serous fluid.

on Aspirate you can see : 

- Simple columnar epithelium ( the red spindly cells " lets say pseudo-spindly always remember this is not a cross section ").

- the dispersed round cells in between on might think  they may represent the intercalated cells and then the diagnosis will be serous cyst But at high magnification you will see that they are full of foamy mucin with pushed nucleus typical of goblet cells. 

- the foamy macrophages   " last pic " indicating the cystic nature of this aspirate 

so we have 2 components the serous and mucinous and the proper diagnosis will be seromucinous cyst 

please note that we cant commet on the malignancy of such neoplasm unless we have H & E sections to asses invasion

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40 years old male patient with testicular mass, the patient underwent radical orchidectomy and this is a smear from the tumor. you can see here the typical features of the germ cell tumor Seminoma classical variant, which are : 

- highly cellular smears 

- multiple bizarre nucleoli seen in side the nuclei 

-infiltrating reactive lymphocytes " smaller and darker in color "