Path Pics Flashcards Preview

Reproductive > Path Pics > Flashcards

Flashcards in Path Pics Deck (162):
1

Q image thumb

normal placenta

first trimester chorionic villi: central stroma surrounded by two layers of epithelium

double arrow (outer layer): syncytiotrophoblasts

single arrow (inner layer): cytotrophoblasts

2

Q image thumb

normal placenta

third trimester chorionic villi: stroma with dense network of dilated capillaries surrounded by markedly thinned out syncytiotrophoblast and cytotrophoblast

3

Q image thumb

Listeria: non-pasteurized milk, cheese

NECROTIZING INTERVILLOSITIS

4

Q image thumb

chorioamnionitis: maternal inflammatory response

5

Umbilical Cord

Q image thumb

INFECTION

top: phlebitis, arteritis in umbilical arteries and veins

middle: necrotizing funisitis due to long standing infection (right)

bottom: peripheral funitis (inflammation at periphery of umbilical cord) with CANDIDA 

6

Q image thumb

chronic villitis with CMV (OWL EYE nuclear inclusion)

7

left: Bone Marrow

right: placenta

Q image thumb

Parvovirus B19: ERYTHEMA INFECTIOSUM (SLAP CHEEK)

left: viral inclusions in early erythroid precursors

right: erythroblasts in the lumen of capillary vessels of placental villi show eosinophilic nuclear inclusions

8

Fetal Membranes

Neg. iron stain

Q image thumb

MECONIUM in amnionic cavity

9

Q image thumb

choroinic villi of plactenta

left: first trimester

right: 3rd trimester (increased vascularity)

cells: outer: syncytiotrophoblasts; inner: cytotrophoblasts

10

Q image thumb

ectopic pregnancy in uterine tube

11

Q image thumb

placenta accreta

placental villi interdigitate directly with the uterine myometrium, without an intervening decidual plate

12

Q image thumb

abruptio placenta

BLOOD

13

Q image thumb

Amnion Nodosum

gross: multiple yellow tan superficial amniotic lesions, usually near insertion of umbilical cord

micro: nodules of eosinophilic fibrous material with entrapped squamous cells

14

Q image thumb

Potters sequence

cranial anomalies, clubbed feet, pulmonary hypoplasia

due to oligohydramnios

15

Q image thumb

Preeclampsia

top: small placenta due to preeclampsia

bottom: placenta with pale infarct (more than 1/3 to 1/2 becomes infarcted: blood supply to infant can become compromised and cause fetal demise)

can also find hematomas

16

placenta

Q image thumb

Preeclampsia

villous ischemia: increased syncytial knots (purple nubbins on villi)

17

maternal vessels in decidua

Q image thumb

Preeclampsia

fibrinoid necrosis 

18

Q image thumb

Complete hydatidiform mole

 villous enlargement, edema, and circumferential trophoblast proliferation

19

ultrasound

Q image thumb

Complete hydatidiform mole

SNOWSTORM 

20

Q image thumb

Partial hydatidiform mole

villi: some normal, others swollen, avascular and grape-like

minimal trophoblastic proliferation

21

Q image thumb

Complete hydatifiform mole

grape-like

22

Q image thumb

Partial hydatidiform mole

23

Q image thumb

Choriocarcinoma

NO villi

mitoses

cytotrophoblasts, syncytiotrophoblasts

24

Q image thumb

Choriocarcinoma

proliferating syncytiotrophoblasts, cytotrophoblasts

NO villi

mitoses

25

Q image thumb

Necrotizing enterocolites (NEC)

A: entire small bowel is distended with perilously thin wall (impending perforation)

B: congested ileum: hemorrhagic infarction and transmural necrosis

arrows: submucosal gas bubbles (pneumatosis intestinalis)

26

Q image thumb

right: Hyaline membrane disease (eosinophilic thick hyaline, atelectasis of alveoli)

left: normal fetal lung

27

Q image thumb

hydrops fetalis

fluid accumulation: particularly prominent in soft tissue of neck (CYSTIC HYGROMA: classic in 45X)

28

Q image thumb

Fibrocystic changes

(yellow is fat)

29

Q image thumb

Fibrocystic change

Pos. if stain for myoepithelial 

30

Q image thumb

Fibrocystic change: non-proliferative

APOCRINE METAPLASIA

31

Q image thumb

normal breast duct

32

Q image thumb

Fibrocystic change: proliferative

USUAL DUCT HYPERPLASIA

lumen full of mixed population of luminal and myoepithelial cells

irregular slit-like fenestrations at periphery

33

Q image thumb

Fibrocystic change: proliferative with atypia

ATYPICAL DUCTAL HYPERPLASIA

monomorphic proliferation of regularly spaced cells sometimes with cribiform spaces (looks like DCIS)

34

Q image thumb

Fibrocystic change: proliferative with atypia

ATYPICAL LOBULAR HYPERPLASIA

cells identical to thos in lobular carcinoma in situ but cells do not fill or distend more than 50% of then acini within a lobule

35

Q image thumb

Fibrocystic change: proliferative

SCLEROSING ADENOSIS

terminal duct lobular unit is enlarged, acini are compressed and distorted by dense stroma

calcifications in some lumens

acini in SWIRL pattern and outer border is well circumscribed

36

Q image thumb

Fibrocystic change: Prolifertive

RADIAL SCLEROSING LESION

A: irregular central mass with long radiodense projections

B: solid with irregular borders, but not as firm as invasive CA

C: central nidus of small tubules entrapped in a densely fibrotic stroma with epithelial projections with cyst formation and hyperplasia

37

Q image thumb

Fat Necrosis

infarcted cells surrounded lipid-laden macrophages

fibrosis, calcifications

38

moveable 

Q image thumb

Fibroadenoma

39

Q image thumb

Fibroadenoma

glands AND stroma

looks like a constellation

40

Q image thumb

Fibroadenoma

ducts AND stroma

CONSTELLATION

41

Q image thumb

Phyllodes tumor

LEAF like

distinguished from fibroadenoma by: higher cellularity, higher mitotic rate, nuclear pleomorphism, STROMAL overgrowth, infiltrative borders

42

Q image thumb

Phyllodes tumor: MALIGNANT

STROMA overgrowth, lots of mitotic figures, densely packed ANAPLASTIC stromal cells, INFILTRATIVE border, tumor necrosis

43

Q image thumb

Intraductal Papilloma

central fibrovascular core extending from wall of duct: lined by BOTH myoepithelial cells and luminal cells

44

Breast

Q image thumb

BRCA1 mutation: (high incidence of medullary and DCIS)

high grade, abundant intra and peritumoral lymphocytes

 

45

Breast

Q image thumb

BRCA2

high grade features and pushing tumor margin

(invasive ductal CA, DCIS)

46

Q image thumb

DCIS: cribiform type

47

Q image thumb

high grade DCIS: COMEDO type

48

Q image thumb

LCIS

uniform low grade monotonous cells

intracellular target mucin

loss of E-CADHERIN

49

Q image thumb

LCIS

50

Q image thumb

Invasive Ductal Carcinoma

atypical ducts in stroma

51

Q image thumb

Invasive Ductal Carcinoma

52

Q image thumb

Invasive Ductal Carcinoma

53

Q image thumb

Lobular Carcinoma

54

Q image thumb

Lobular Carcinoma

55

Q image thumb

Invasive Lobular Carcinoma

INDIAN FILE

bland, usually estrogen pos.

56

Breast

Associated with what mutation?

Reoccurence risk?

Q image thumb

Medullary Carcinoma

high grade cells growing in sheets; lymphocytes and plasma cells

BRCA1, reccurences are rare

57

Q image thumb

Meduallary Breast Carcinoma

indistinc cell borders (syncytial growth), large pleomosphic tumore cells with large nuclei, prominent nucleoli, mitotic figures

lymphoplasmacytic infiltrate at periphery

pushing borders/well circumscribed

58

Breast

Prognosis?

Age?

Q image thumb

Colloid/ Mucinous Carcinoma

good prognosis

older women: around 70 yrs

59

Breast

Prognosis?

Q image thumb

Tubular carcinoma

distinct well differentiated angular tubular structures (tadpoles), open lumina, lined with single layer of epithelial cells

good prognosis

60

Breast

Prognosis?

Q image thumb

Micropapillary variant

poor prognosis (most have lymph node metastases at presentation, recurrence, half die)

61

Breast

Q image thumb

Paget's Disease of Nipple

due to underlying CA

 

62

Breast with NO palpable mass

Prognosis?

Micro?

Q image thumb

Inflammatory Carcinoma (reoccurence)

enlarged swollen erythematous breast

top arrows: inflammation

bottom arrow: mastectomy scar

Poor prognosis (survival less than 1/2; even lower with metastases)

poorly differentiated, diffusely infiltrative

63

Q image thumb

Peau d'orange

thickened skin due to lymphatic congestion

64

Male: breast

Q image thumb

gynecomastia

NO lobules, increase ducts, prominent stroma; can be edematous with incresased cellularity

late phase may have fibrosis 

65

Q image thumb

Herpes

margination, molding, multinucleation

66

Transmission?

Q image thumb

Molluscum contagiosum (pox virus)

children: direct contact or shared objects

adults: sexually transmitted

67

How might a women get this?

Q image thumb

Candida

pseudohyphae

result of disturbacne of vaginal microbial ecosystem: DM, antibiotics, pregnancy, compromised immune system

68

Symptoms?

Q image thumb

Trichomonas vaginalis (protozoan)

Sx: YELLOW, FROTHY vaginal discharge; vulvovaginal discomfor, dysuria, dyspareunia

bottom: marked dilatation of cervical mucosal vessels resulting in STRAWBERRY CERVIX

69

Symptoms?

Q image thumb

Gardnerella vaginalis (G- bacillus)

Sx: thin GRAY, FISHY discharge

CLUE cell

70

Q image thumb

PID

top: normal fallopian tube

A: acute salpingitis: dilated lumen and edematous tubal plicae (folds) expanded by inflammatory cell infiltrates, pus in center of tube

B: chronic salpingitis with scarring and fusing of plicae

71

What causes this to occur?

Q image thumb

Fitz-Hugh-Curtis syndrome (PERIHEPATITIS)

caused by: PID

72

Vulva

Differential?

Q image thumb

LEUKOPLAKIA: white patch, atrophy of skin, vaginal stenosis

Differential: squamous cell carcinoma, Lichen Simplex Chronicus, Lichen Sclerosis

73

Q image thumb

Lichen Sclerosis

thinned epidermis, sclerosis of superficial dermis, chronic inflammatory cells

74

Q image thumb

Lichen Simplex Chronicus

Thickened epidermis

75

Cause?

Q image thumb

Condyloma Accuminatum: HPV 6 and 11

koilocytic cell, binucleate, clear around nucleus

 

76

Vulva

Q image thumb

HPV pos. Vulvar Intraepithelial Neoplasia (VIN)

whole surface looks the same: basal cells

left: in situ 

right: invasive (can't see BM)

NON-KERATINIZING: younger women

77

Vulva

Q image thumb

HPV neg. Vulvar Intraepithelial Neoplasia (VIN)

KERATINIZING: older woman

78

Vulva

Q image thumb

Paget disease

intraepithelial proliferation of malignant cells confined to epidermis

 

79

Vagina: Less than 5 years old

Death caused by?

Q image thumb

Embryonal Rhabdomyosarcoma: Sarcoma Botryoides

RHABDOMYOBLAST

death: penetration into peritoneal cavity or obstruction of urinary tract

80

Cervix

Where is the highest viral load?

Q image thumb

High risk HPV: Raisin nuclei, Binucleate, Koilocytic with clearing around nuclei

Left: normal

left middle: CIN I

right middle: CIN II (mitotic figure in middle to top area)

right: CIN III

do not need low grade lesion to develop high grade lesion

highest viral load: top

81

Cervix 

Stain(s)?

Q image thumb

HPV infection

Stain: p16 and Ki-67

A: LSIL

B: dark granular staining denotes HPV DNA abundant in koilocytes

C: Ki-67 brown nuclear stain, abnormal expansion of proliferating cells

D: upregulation of p16 (brown stain) characterized high risk HPV infection

82

Cervix

Q image thumb

Invasive squamous cell carcinoma

top: microinvasion in CIN III

bottom: keratin

83

Cervix

Q image thumb

left: adenocarcinoma in situ

right: invasive adenocarcinoma

84

Cervix cytology

Q image thumb

top left: normal

top right: LSIL

bottom: HSIL

85

Tissue?

Phase?

Q image thumb

endometrium: proliferative phase

columnar epithelium with tubular glands

86

Tissue?

Phase?

Q image thumb

Endometrium: secretory phase

87

Endometrium: Phase?

Q image thumb

top: early secretory

bottom: late secretory

88

Tissue?

Phase?

Q image thumb

endometrium: menstrual phase

clumps of cells and glands with BLOOD

89

Uterus

Q image thumb

polyp

90

Uterus

What drug can cause this?

Q image thumb

Endometrial Polyp

cystic change, large thick walled vessels, fibrous stroma

Drug: Tamoxifen

 

91

92

Endometrium

Common cause?

Tx?

Q image thumb

Acute Endometritis

common cause: retained products of conception

Tx: antibiotics, D&C

93

Endometrium

Associations?

Q image thumb

Chronic Endometritis

PLASMA CELLS

assoiciated with: PID, retaind gestational tissue, IUD, TB (miliary or drainage from tuberculosis salpingitis)

94

Woman with Cu IUD with bad smelling discharge

Q image thumb

Actinomyces

sulfur granuloma

pseudofilamentous material with ACUTE ANGLE branching

G pos. bacteria

95

Outside of uterus

Q image thumb

endometriosis

96

Outside of Uterus

What 3 things are required for Dx?

Q image thumb

Endometriosis

endometrial glands, stroma, hemosiderin

97

Endometrium

Q image thumb

left: Simple hyperplasia no atypia (mild glandular crowding and cystic glandular dilation)

right: normal proliferation

98

Endometrium

Q image thumb

Complex hyperplasia no atypia

increased glandular crowding with areas of back to backglands and cytologic features similar to proliferative endometrium

99

Endometrium

Q image thumb

Complex hyperplasia with atypia

very little stroma (CA will have NONE)

100

Endometrium

Q image thumb

complex hyperplasia with atypia

very little stroma, apoptotic debris

101

Endometrium

Grade?

Q image thumb

Endometrioid Carcinoma (hyperplasia pathway)

top right: Grade 1 (less than 5% nonsquamous growth pattern)

bottom left: Grade 2 (6-50%)

bottom right: Grade 3 (greater than 50%)

102

Endometrium

Grade?

Stain?

Q image thumb

Serous Carcinoma (sporadic pathway)

grade 3 for any histologic pattern

stain: p53

103

Endometrium

 

Q image thumb

Malignant Mixed Mullerian Tumor (MMMT) aka carcinosarcomas

left: epithelial and stromal components appear to be derived from same cell

right: only epithelial components: tumors with heterologous mesenchymal components do worse

poor prognosis

104

Q image thumb

Leiomyoma

 

105

Q image thumb

Leiomyosarcoma

106

Ovary

Q image thumb

Follicular Cyst

granulosa lining cells present if intraluminal pressure not so great to cause atrophy

theca cells may be conspicuous due to increased amount of pale cytoplasm

107

Ovary

Q image thumb

Corpus Leuteal Cyst

present in normal ovaries of reproductive women

lined by rim of bright yellow tissue containing luteinized granulosa cells

occasionally rupture: peritoneal rxn

108

Ovary

Q image thumb

serous cystadenoma

stromal papillae with a columnar epithelium

109

Ovary

Q image thumb

Serous Cystadenofibroma

110

Ovary

Q image thumb

Borderline Serous tumor

increased architectural complexity and epithelial cell stratification

111

Ovary

Q image thumb

Serous Carcinoma

left: low grade (complex micropapillary growth)

right: high grade (invasion of underlying stroma)

112

Ovary

Mutation?

How to tell benign vs. malignant?

Q image thumb

Mucinous cystadenoma

benign: fluid

malignant: papillary solid stuff, stromal invasion

mutation: KRAS

113

extensive mucinous ascites, cystic epithelial implants on peritoneal surfaces, adhesions, frequent involvement of ovary

source?

Q image thumb

pseudomyxoma per-itonei

usually from appendix

114

Ovary

What pathology might this co-exist with?

Q image thumb

endometrioid adenocarcinoma

some have: endometriosis

115

Ovary

Associated with?

Q image thumb

right: Brenner tumor (resemble urothelium)

associated with: left: teratoma

116

Ovary

origin?

Q image thumb

Kruckenberg tumor 

origin: gastric

bilateral: mucin producing, SIGNET RING cells

117

Ovary

Secrete?

Behave?

IHC Ab?

Q image thumb

Granulosa tumor

CALL EXNER bodies: small follicle like structures

secrete: estrogen

behave: low grade malignancy

Ab: inhibin

118

Ovary

Associated syndrome(s)?

Q image thumb

Fibroma, Fibrothecoma, Thecoma

Meigs syndrome and basal cell nevus syndrome

119

Ovary

Secrete?

Q image thumb

Sertoli Leydig cell tumor

produce: testosterone (occasionally estrogen)

masculinization 

120

Ovary

Q image thumb

Mature Teratoma

121

Ovary

Q image thumb

Mature Teratoma

left: neural tissue, middle: hair

122

Ovary

Risk for extraovarian spread?

Q image thumb

Immature Teratoma

resembles embryonal and immature fetal tissue

risk for spread: grade of tumor based on proportion of tissue containing NEUROEPITHELIUM

 

123

Ovary

Q image thumb

Struma Ovarii: monodermal teratoma

thyroid tissue

124

Ovary

Where else might it be present?

Expresses?

Q image thumb

Dysgerminoma

other places: mediastinum, pineal gland, retroperitoneum

express: receptor kinase KIT

125

Ovary

What is elevated in the serum?

Q image thumb

Yolk Sac tumor

Schiller-Duval body, hyaline droplets

serum: AFP

126

Q image thumb

Candida albicans

GERM TUBE

127

Penis

Gross?

Who in?

Q image thumb

Squamous Cell Carcinoma: HPV

gross: ulceration

who: uncricumcised

128

Sudden onset of pain

Fix by?

Q image thumb

Testicular torsion

fix within 6 hours

129

Testis

Age?

What can be seen in some cases histologically (not this one)?

Q image thumb

Seminoma

age: 20s and 30s

sheets of polygonal cells with lymphocytes in the stroma

in some cases: syncytiotrophoblasts

130

Testis

What can happen with chemo?

Q image thumb

embryonal carcinoma

undifferentiated cells and primitive gland-like structures, large hyperchromatic nuclei

chemo: cells can mature and differentiate

131

Testis

Age?

Stain for?

Circles? what do they resemble?

Q image thumb

Yolk sac tumor

eosinophilic hyaline globules: alpha1-antitrypsin and AFP

Schiller-Duval bodies: loosely textured microcystic tissue and papillary structures resemble glomerulus

132

Testis

Arrowhead? Arrow?

IHC and serum?

Spread?

 

Q image thumb

Choriocarcinoma

cytotrophoblastic cells with central nuclei (arrowhead); syncytiotrophoblastic cells with multiple dark nuclei in eoisinophilc cytoplasm (arrow)

IHC and serum: hCG (within syncytiotrophoblasts)

Spread: heatagenous

hemorrhage, necrosis

133

Testis

More common in?

When is it benign? Malignant

Q image thumb

Teratoma

more common in children than adults

benign: pre-pubertal

malignant: post-pubertal

A: neural (ectoderm)

B: glandular/ GI (endoderm)

C: cartilaginous (mesoderm)

D: squamous epithelial 

134

Prostate

most common cause?

Q image thumb

Prostatitis

cause: E. coli or other GNR

135

Prostate

Stimulus?

Sx?

Complication?

Q image thumb

Bengin prostate hyperplasia: proliferation of STROMAL and GLANDULAR elements

2 layers: BENIGN

stimulus: DHT

Sx: hesitancy, urgency, nocturia

complication: UTI due to obstruction

 

136

Prostate

location?

Q image thumb

Adenocarcinoma

lower left: posterior, peripheral

137

Prostate

Grade?

Q image thumb

Adenocarcinoma

right: shows perineural invasion

grade 3: lots of individual glands

138

Prostate

Grades?

Q image thumb

Adenocarcinoma

top: grade 3 (lots of glands)

middle: grade 4 (glands start going together)

bottom: grade: 5 (no glands really)

139

Prostate

Q image thumb

Cancer

right: only one cell layer with prominent nucleoli 

140

Prostate

Stain?

Q image thumb

Cancer

IHC: RACEMASE

brown is normal basal cells of benign gland

red: malignant cells

141

Q image thumb

normal urothelium

umbrella cells

142

Q image thumb

normal urothelium

143

Q image thumb

top: urteropelvic junction obstruction

causes (most common cause): bottom: hydronephrosis

can be bilateral

144

Q image thumb

double/bifid ureter

unilateral usually

145

What can this lead to?

Q image thumb

diverticula of ureter: outpouching of ureteral wall

can cause: urinary stasis with recurrent infection

146

ureter, renal pelvis, calyces, or bladder

 

Q image thumb

low grade papillary urothelial carcinoma

147

Ureter

Causes?

Related to what disease?

age?

Q image thumb

Sclerosing retroperitoneal fibrosis

tubulointerstitial with fibrous and prominent infiltrate of lymphocytes, PLASMA CELLS (IgG4 pos.), eosinophils

can cause: ureteral narrowing or obstruction

related to: Riedels thyroiditis, IgG4 (elevated IgG4 and fibroinflammatory lesions rich in IgG4 secreting plasma cells)

middle to late age

148

Q image thumb

Exstrophy of the bladder

149

Bladder

Q image thumb

Cystitis

top: malakoplakia raised mucosal plaques

bottom: foamy macrophages (abundant granular cytoplasm), multinucleate giant cells, lymphocytes

MICHAELIS-GUTMANN bodies:  Ca deposition

150

Bladder

Causes?

Q image thumb

Bladder cancer

caused by: smoking, occupational (hair dresser), SCHISTOSOMA HAEMATOBIUM

151

Bladder

Q image thumb

Carcinoma in situ

flat lesion: umbrella cells are gone and even falling off

152

Bladder

Q image thumb

low grade urothelial carcinoma

153

Bladder

Q image thumb

High grade urothelial carcinoma

154

Bladder

Q image thumb

Invasive urothelial carcinoma

155

Bladder

Q image thumb

Invasive urothelial carcinoma

156

Bladder

50% have what?

Q image thumb

Invasive bladder cancer

half have occult metastatic disease

157

Stain that shows organism?

Q image thumb

Syphilis

top: chancre, PAINLESS and heal spontaneously

bottom: proliferative endarteritis, PLASMA cells

stain: silver

158

Stain?

Q image thumb

Syphilis: spirochetes

stain: Silver

159

Q image thumb

tertiary Syphilis

GUMMA: coagulative necrosis by a mixed inflammatory infiltrate composed of lymphocytes, plasma cells, activated macrophages, giant cells, peripheral zone of dense fibrous tissue

160

Q image thumb

Trichomoniasis

161

Q image thumb

Genital Herpes Simplex

nuclear inclusions make them look smudgy and glassy (light on inside and dark on outside)

162

urethra

Tx?

Q image thumb

urethral caruncle

inflammatory granulation tissue covered by intact friable mucosa which may ulcerate and bleed with slight trauma

small, red, painful mass on the external urethral meatus in older females

Tx: surgical excision