Benign fibroadenoma in the breast. CT capsule confining tumor, no hemorrhaging, no necrosis, no angiogenesis and shiny surface (lack of dense collagen in tumor)
Malignant breast tumor. Note hemorrhage site from previous tumor biopsy, that is where the carcinoma is. White part is normal breast tissue, dull, yellowish portion is the malignant part.
Normal breast with ducts, tubes and uniform organization
Breast benign fibroadenoma. Note pale stroma, elongated/branching glands that are self-contained and widely separated in the stroma.
Where do breast tumor cells originate from?
Stromal cells in the lobules
Note two cell layers: myoepithelial cells and inner glandular epithelial layer.
Malignant breast tumor. Note mass of cells with little tendency to form glands, poor differentiation, infiltrating border and large purple nuclei.
You look at a slide and note the cells forming glands, hyperchromatic and giant cells. What information is the oncologist looking to get from the pathologist?
Tumor grade. The doctor wants to know how differentiated the tumor is.
Higher power image of malignant breast tumor. Note large and deep staining hyperchromatic nuclei.
How can you decide whether something is an adenocarcinoma or not?
Mucin production and attempts to form glands
An oncologist wants you to determine how far the tumor has invaded into surrounding tissue, if it has metastasized to lymph nodes or to different organs. What does she want?
Malignant breast tumor with highly pleomorphic cells and mitoses.
A patient comes to your office for a routine gynecology exam. What test might you do that allows you to look at cells apart from their normal architecture?
Pap smear. This test is an example of cytological analysis.
Normal cervix, notice squamous epithelium in cervix and glandular columnar epithelium of endocervix that meet at the squamo-columnar junction. Note apical pyknotic layer with no mitoses and pyknoses and basal cuboidal layer
Normal pap-smear. Small round dark staining nucleus.
Normal pap smear of columnar epithelium from endocervix. Note evenly spaced and uniform nuclei.
Moderate dysplasia. Note the nuclei remain large more than halfway up into the cervix before they start to flatten out. Also note metaplasia in the lower endocervix that has spread from the cervix.
Carcinoma in situ. Note lack of differentiation all the way to the apical layer and in tact basement membrane.
Abnormal pap smear. Note increase in nuclei:cytoplasm ration, clumpy hyperchromatic nucleus, and notches/irregularities in the nucleus.
Cervical carcinoma with large polypoid mass coming from the ectcervix
Invasive cervical squamous carcinoma. Note pleomorphic cells with large hyperchromatic nuclei.
You are pathologist and look at a carcinoma with cells that are connected by desomsome with pink staining cytoplasm. What type of carcinoma are you looking at?
Squamous cell carcinoma. Pink stain comes from keratin produced by these cells.
Malignant colon adenocarcinoma. Note necrosis, ulceration, "heaped up" border from infiltration of wall and narrowing of lumen.
Note tumor infiltration of wall and narrowing of lumen.
What are the different shapes and sizes of tumors?
Polypoid fungating mass in the right side of the colon.
Colon with adenocarcinoma. Note uniform goblet cells, separated one from another by CT in center; but dark-staining mass of large nuclei and shared glands in the tumor in the upper left
Back to back glands
Indicative of adenocarcinoma.
Invasion of muscularis propria of the colon. Note central necrosis surrounded by neoplastic cells.
Metastasis of adenocarcinoma from the colon in the lymph node. Note sheets of lymphocytes.
Dukes A tumor
Partial invasion of muscle wall
Dukes B tumor
Goes into entire wall and serosal fat
Dukes C tumor
Lymph nodes are affected by metastasis
Dukes D tumor
Metastasis to distant organs
Liver with metastatic liver cancer. Note tumors with dark center area of necrosis.
What is the difference between a cirrhotic liver and a cancerous liver?
Cirrhotic liver does not have any normal areas. Cancerous liver had nodules spread throughout the tissue.
Bone cancer which was a metastasis from the prostate. Note cancer infiltration of bone.
A patient has cancer of the bone but doesn't know it. What symptoms may he/she present with in clinic?
Hypercalcemia and pathological fractures
A male comes to your office complaining of testicular pain. Suspecting testicular cancer, you put in for a test testing for a certain tumor marker. What marker would this be?
Before referring a patient to have a tumor excised from his colon, you want to estimate his prognosis with a particular tumor marker. What marker might you test for?
CEA (Carinoembryonic Antigen)
A patient presents to your office with jaundice and cachexia. You order a test to rule out cancer. What will the test be analyzing?
A patient comes to your clinic complaining of back pain and vaginal bleeding. You order a blood test for CA-125. What might the cytologist see if the CA-125 came back positive?
A patient presents with typical CRAB symptoms (Calcium, Renal failure, Anemia, and Bone lesions). What test might you run to rule out myeloma in this patient?
Immunoglobulin test to see if there is an extraordinarily high level of a single Ig in the blood being produced by possibly cancerous WBCs.
A young patient presents to your office with blood in his stool. Various relatives have had similar symptoms. What tumor marker might you test for in his case?
APC. It is tumor repressor and regulates beta-catenin in the WNT signaling pathway.
Females with this syndrome have nearly 100% lifetime risk of developing some cancer. How would you test to see if a patient had this rare disease?
Genetic testing for a p53 mutation resulting in LiFraumeni Syndrome.
Through genetic testing, you diagnose a patient with a mutated NF1 gene resulting in neurofibromatosis type I. What signaling pathway component causes neurofibromatosis?
RAS. NF1 codes for neurofibromin which is a negative regulator of RAS. Without this protein, RAS stays active.
Benign tumor of the thyroid. Note CT capsule separating it from the normal thyroid parenchyma.
Normal thyroid parenchyma on the left, benign tumor on the right.
A good shot of the capsule separating a benign thyroid tumor from the thyroid parenchyma. Note prominent blood vessels within tumor.
Benign thyroid tumor. Note the cuboidal thyroid follicular epithelium with little or no colloid within the follicles.
What would the lung look like of a 65 year old female that has smoked for 25 years? She came to your clinic complaining of a cough and Cushingoid features.