Anticentromere antibodies
Scleroderma (CREST)
Antidesmoglein (epithelial) antibodies
Pemphigus vulgaris (blistering)
Anti-glomerular basement membrane antibodies
Goodpasture syndrome (glomerulonephritis and hemoptysis)
Antihistone antibodies
Drug-induced SLE (hydralazine, INH, phenytoin, procainamide)
Anti-IgG antibodies
Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)
Antimitochondrial antibodies (AMAs)
Primary biliary cirrhosis (female, cholestasis, portal hypertension)
Antineutrophil cytoplasmic antibodies (ANCAs)
Microscopic polyangiitis and Churg-Strauss syndrome (MPO-ANCA/p-ANCA); granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA)
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA)
SLE (type III hypersensitivity)
Antiplatelet antibodies
Idopathic thrombocytopenic purpura
Anti-topoisomerase antibodies
Diffuse systemic scleroderma
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, distentionm, weightloss)
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies
Celiac disease (diarrhea, distention, weight loss)
“Apple core” lesion on abdominal x-ray
Colorectal cancer (usually left-sided)
Azurophilic peroxidase positive granular inclusions on granulocytes and myeloblasts
Auer rods (AML, especially the promyelocytic [M3] type)
Bacitracin response
Sensitive: Streptococcus pyogenes (group A);
Resistant: Streptococcus agalactiae (group B)
“Bamboo spine” on x-ray
Ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
Basophilic nuclear remnants in RBCs
Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Basophilic stippline of RBCs
Lead poisoning or sideroblastic anemia
Bloody tap on LP
Subarachnoid hemorrhage
“Boot-shaped” heart on x-ray
Tetralogy of Fallot, RFH
Branching gram-positive rods with sulfur granules
Actinomyces israelii
Bronchogenic apical lung tumor on imaging
Pancoast tumor (can compress sympathetic ganglion and cause Horner syndrome)
“Brown” tumor of bone
Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives a brown color)
Cardiomegaly with apical atrophy
Chagas disease (Trypanosoma cruzi)
Cellular crescents in Bowman capsule
Rapidly progressive crescentic glomerulonephritis
“Chocolate cyst” of ovary
Endometriosis (frequently involves both ovaries)
Circular grouping of dark tumor cells surrounding pale neurofibrils
Homer-Wright rosettes (neuroblastoma, medulloblastoma, retinoblastoma)
Colonies of mucoid Pseudomanas in lungs
Cystic fibrosis (autosomal recessive mutation in CFTR gene, leads to fat-soluble vitamin deficiency and mucous plugs)
Decreased AFP in amniotic fluid/maternal serum
Down syndrome or other chromosomal abnormality
Degeneration of dorsal column nerves
Tabes dorsalis (tertiary syphilis), subacute combined degeneration (dorsal columns and lateral corticospinal tracts affected)
Depigmentation of neurons in substantia nigra
Parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
Desquamated epithelium casts in sputum
Curschmann spirals (bronchial asthma; can result in whorled mucous plugs)
Disarrayed granulosa cells in eosinophilic fluid
Call-Exner bodies (granulosa-theca cell tumor of the ovary)
Dysplastic squamous cervical cells with nuclear enlargement and hyperchromasia
Koilocytes (HPV: predisposes to cervical cancer)
Enlarged cells with intranuclear inclusion bodies
“Owl eye” appearance of CMV
Enlarged thyroid cells with ground-glass nuclei
“Orphan Annie” eyes nuclei (papillary carcinoma of the thyroid)
Eosinophilic cytoplasmic inclusion in liver cell
Mallory body (alcoholic liver disease)
Eosinophilic cytoplasmic inclusion in nerve cell
Lewy body (Parkinson disease)
Eosinophilic globule in liver
Councilman body (toxic or viral hepatitis, often yellow fever)
Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar nerve cells
Negri bodies of rabies
Extracllular amyloid deposition in gray matter of brain
Senile plaques (Alzheimer disease)
Giant B cells with bilobed nuclei with prominent inclusions (“owl’s eye”)
Reed-Sternberg cells (Hodgkin lymphoma)
Glomerulus-like structure surrounding vessel in germ cells
Schiller-Duval bodies (yolk sac tumor)
“Hair on end” (crew-cut) appearance on x-ray
Beta-thalassemia, sickle cell anemia (marrow expansion)
hCG elevated
Choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)
Heart nodules (granulomatous)
Aschoff bodies (rheumatic fever)
Heterophile antibodies
Infectious mononucleosis (EBV)
Hexagonal, double-pointed, needle-like crystals in bronchial secretions
Bronchial asthma (Charcot-Leyden crystals: eosinophilic granules)
High level of D-dimers
DVT, PE, DIC
Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)
Ghon complex (primary TB: Mycobacterium bacilli)
“Honeycomb lung” on x-ray or CT
Interstitial pulmonary fibrosis
Hypercoagulability (leading to migrating DVTs and vasculitis)
Trousseau syndrome (adenocarcinoma of pancreas or lung)
Hypersegmented neutrophils
Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency: no neurologic symptoms)
Hypertension, hypokalemia, metabolic alkalosis
Conn syndrome
Hypochromic, microcytic anemia
Iron deficiency anemia, lead poisoning, thalasssemia (fetal hemoglobin sometimes present)
Increased AFP in amniotic fluid/maternal serum
Dating error, anencephaly, spina bifida (neural tube defects)
Increased uric acid levels
Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop and thiazide diuretics
Intranuclear eosinophilic droplet-like bodies
Cowdry type A bodies (HSV or CMV)
Iron-containing nodules in alveolar septum
Ferruginous bodies (asbestosis: increased chance of mesothelioma)
Keratin pearls on a skin biopsy
Squamous cell carcinoma
Large lysosomal vesicles in phagocytes, immunodeficiency
Chediak-Higashi disease (congenital failure of phagolysosome formation)
“Lead pipe” appearance of colon on barium enema x-ray
Ulcerative colitis (loss of haustra)
Linear appearance of IgG deposition on glomerular basement membrane
Goodpasture syndrome
Low serum ceruloplasmin
Wilson disease (hepatolenticular degeneration)
“Lumpy bumpy” appearance of glomeruli on immunofluoresence
Poststreptococcal glomerulonephritis (Immune complex deposition of IgG and C3b)
Lytic (“hole-punched”) bone lesions on x-ray
Multiple myeloma
Mammary gland (“blue domed”) cyst
Fibrocystic change of the breast
Monoclonal antibody spike
Multiple myeloma (usually IgG or IgA) Monoclonal gammopathy of undetermined significance (MGUS consequence of aging) Waldenstrom (M protein = IgM) macroglobulinemia Primary amyloidosis
Mucin-filled cell with peripheral nucleus
“Signet ring” (gastric carcinoma)
Narrowing of bowel lumen on barium x-ray
“String sign” (Crohn’s disease)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis
Granulomatosis with polyangiitis (Wegener; PR3-ANCA/c-ANCA) and Goodpasture syndrome (anti-basement membrane antibodies)
Needle-shaped, negatively birefringent crystals
Gout (monosodium urate crystals)
Nodular hyaline deposits in glomeruli
Kimmelstiel-Wilson nodules (diabetic nephropathy)
Novobiocin response
Sensitive: Staphylococcus epidermidis;
Resistant: Staphylococcus saprophyticus
“Nutmeg” appearance of liver
Chronic passive congestion of liver due to right heart failure
Narrowing of bowel lumen on barium x-ray
“String sign” (Crohn disease)
“Onion skin” periosteal reaction
Ewing sarcoma (malignant round-cell tumor)
Optochin response
Sensitive: Streptococcus pneumoniae;
Resistant: viridans streptococci
Periosteum raised from bone, creating triangular area
Codman triangle on x-ray (osteosarcoma, Ewing sarcoma, pyogenic osteomyelitis)
Podocyte fusion or “effacement” on electron microscopy
Minimal change disease (child with nephrotic syndrome)
Polished, “ivory-like” appearance of bone at cartilage erosion
Eburnation (osteoarthritis resulting in bony sclerosis)
Protein aggregates in neurons from hyperphosphorylation of tau protein
Neurofibrillary tangles (Alzheimer disease) and Pick bodes (Pick disease)
Psammoma bodies
Meningiomas, papillary thyroid carcinoma, mesothelioma, papillary serous carcinoma of the endometrium and ovary
Pseudopalisading tumor cells on brain biopsy
Glioblastoma multiforme
RBC casts in urine
Acute glomerulonephritis
Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells
Reinke crystals (Leydig cell tumor)
Renal epithelial casts in urine
Acute toxic/viral renal injury
Rhomboid crystals, positively birefringement
Pseudogout (calcium pyrophosphate dihydrate crystals)
Rib notching
Coarctation of the aorta
Ring-enhancing brain lesion in AIDS
Toxoplasma gondii, CNS lymphoma
Sheets of medium-sized lymphoid cells with scattered pale, tingible body-laden macrophages (“starry sky” histology)
Burkitt lymphoma (t[8:14] c-myc activation, associated with EBV; “black sky” made up of malignant cells)
Silver-staining spherical aggregation of tau proteins in neurons
Pick bodies (Pick disease: progressive dementia, changes in personality)
“Soap bubble” in femur or tibia on x-ray
Giant cell tumor of bone (generally benign)
“Spikes” on basement membrane, “dome-like” subepithelial deposits
Membranous glomerulonephritis (may progress to nephrotic syndrome)
Stacks of RBCs
Rouleaux formation (high ESR, multiple myeloma)
Stippled vaginal epithelial cells
“Clue cells” (Gardnerella vaginalis)
“Tennis racket”-shaped cytoplasmic organelles (EM) in Langerhans cells
Birbeck granules (Langerhans cell histiocytosis or histiocytosis X: eosinophilic granuloma)
Thrombi made of white/red layers
Lines of Zahn (arterial thrombus, layers of platelets/RBCs)
“Thumb sign” on lateral x-ray
Epiglottitis (Haemophilus influenzae)
Thyroid-like appearance of kidney
Chronic bacterial pyelonephritis
“Tram-track” appearance of capillary loops of glomerular basement membranes on light microscopy
Membranoproliferative glomerulonephritis
Triglyceride accumulation in lever cell vacuoles
Fatty liver disease (alcoholic or metabolic syndrome)
“Waxy” casts with very low urine flow
Chronic end-stage renal disease
WBC casts in urine
Acute pyelonephritis
WBCs that look “smudged”
CLL (almost always B cell)
“Wire loop” glomerular capillary appearance on light microscopy
Lupus nephropathy
Yellowish CSF
Xanthochromia (e.g., due to subarachnoid hemorrhage)
