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116 Cards in this Set

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Respiratory sample
Respiratory sample
Creola body

ciliated cells with lots of vacs
mimics adenoca
asthma
BENIGN
Respiratory sample
Respiratory sample
Curshman spiral

Inspissated mucous
Respiratory sample
Respiratory sample
Ciliocytopthoria

Just the cilia. Mimics organisms.

ASSOCIATED WITH VIRUSES
Respiratory sample. what is this? what stain?
Respiratory sample. what is this? what stain?
PCP

Pap stain (fuzzy exudates)
PCP Diff quik stain outlines cyst forms and trophs in macrophages
stain?
stain?
GMS

PCP cyst form
FNA lung mass
FNA lung mass
Benign mesos, contaminant

Flat cohesive sheets
Round nuclei, small neucleoli
WINDOWS
Alternaria
contaminant
snowshoe conidia with horiz & vertical lines
Septate
Alternaria
contaminant
snowshoe conidia with horiz & vertical lines
Septate
Measles virus infection causes pneumonia with giant multinucleated epithelial cells that have eosinophilic intranuclear and intracytoplasmic inclusions. These
cells are pathognomonic.
TB
The nodular aggregate of epithelioid histiocytes, which defines the granuloma, has a syncytial
appearance because individual cell borders are indistinct. Note the curved and elongated, boomerang shape of some of the histiocytic nuclei. Interspersed lymphocytes can also be seen.
PCP
The Giemsa stain outlines the cysts as negative
images, and stains the intracystic bodies or trophozoites. Each cyst, as seen here, contains eight intracystic bodies.
Wegener's granulomatosis
Neutrophils, giant cells, necrotic collagen
Necrosis
Granulomatous inflammation

granular background debris consisting of necrotic collagen without acute inflammation is characteristic
Vasculitis
Pulmonary alveolar proteinosis (PAP) is a rare disease
characterized by an accumulation of a lipid-rich material within alveoli.

The characteristic findings include an opaque, milky gross appearance; large, acellular, eosinophilic, blobs that are positive for periodic acid-Schiff; and pulmonary macrophages filled with material that is positive for periodic acid-Schiff.
Smears from a pulmonary hamartoma show fragments of myxoid material, chondroid material, or both. Chondrocytes in lacunae, which are green with Papanicolaou’s stain, but unstained on H&E.
• benign glandular cells
• immature fibromyxoid matrix and bland spindle
cells
• mature cartilage with chondrocytes in lacunae
• adipocytes
HMGI(Y) gene on chromosome 6p21.
Patient under 40y
Peripheral discrete nodule
Bland spindle cells storiform pattern
Inflammatory myofibroblastic tumor
Unpredictable behavior
ALK gene translocations
Why do we separate out small cell carcinoma?
Usually metastatic at presentation, and treated with chemo.

Surgery for others
SCC, well-diff
• abundant dyshesive cells
• polymorphic cell shapes: polygonal, rounded,
elongated (fiber-like), tadpole shaped
• dense cytoplasmic orangeophilia (Papanicolaou
stain)
• pyknotic nuclei
• frequent anucleate cells
abundant granular debris
SCC, poorly differentiated
• large, cohesive clusters of elongated cells
• rare to absent keratinization
• large nuclei
• coarse chromatin texture (“Idaho potato”)
• ± prominent nucleoli
Where are adenocarcinomas of the lung usually located? What molecular test?
Peripheral

EGFR
Adeno of the lung
The glandular differentiation can be easily appreciated. Cells are columnar, with polarized nuclei and single prominent nucleoli.
Mucinous BAC
(looks like papillary thyroid)
uniform cells with pale, optically clear nuclei and inconspicuous nucleoli. Grooves and nuclear pseudoinclusions are often present
Peripheral mass
Peripheral mass
Large cell neuroendocrine carcinoma
• syncytial clusters and dispersed cells
Palisading, MOLDING, ROSETTES
MITOSES, NECROSIS
• irregular nuclei
• striking chromatin clearing
• prominent, often multiple nucleoli
• ill-defined, feathery cytoplasm
Subtypes of Large cell carcinoma?
Basaloid carcinoma (NOT peripheral)
Lymphoepithelioma-like carcinoma
Clear cell carcinoma
Large cell neuroendocrine
LCC with rhabdoid phenotype
CD31positive lung mass
CD31positive lung mass
Epithelioid angiosarcoma
Mimics LCC

CD31, CD34+
(30%+ cytokeratins...)
Male, 30s, tumor resembles fetal lung
Pulmonary blastoma
-Biphasic neoplasm
- Spindled component (myxoid, chondroid, osteoid, rhabdo)
-Epithelial (tubules with piano key appearance)

(Tumors of just the epithelioid portion called FETAL ADENOCA)
Most specific neuroendocrine marker?
chromogranin A
Carcinoids (typical & atypical) vs SmCC/LCNEC?
MITOTIC RATE
<10/10hpf

and lack of necrosis
typical carcinoid
80% are POSITIVE for keratins!
30% are POSITIVE for TTF1!

• loosely cohesive groups and single cells
• rosette-like structures
• round, plasmacytoid, or elongated cells
• uniform nuclei with “salt and pepper” chromatin
• ample granular cytoplasm
• branching capillaries
• mitoses uncommon
• no necrosis
RBCs
Atypical carcinoid
All the features of typical carcinoid can be seen, but
greater pleomorphism, slight nuclear enlargement, an increased number of mitoses, and focal necrosis are important distinguishing elements.
Central mass
Central mass
Small cell carcinoma
90% CENTRAL
• small cells (twice the size of lymphocytes)
• evenly dispersed, powdery chromatin
• nuclear molding
• small to indistinct nucleoli
• paranuclear blue bodies
• mitoses
• background of nuclear debris and crush artifact
HMB45+
Clear cell sugar tumor (PEComa)
HMB45+/MelanA+; keratin -
Benign
extremely rare and can occur in
persons of all ages, most of whom are asymptomatic. It
is usually a peripheral mass and ranges from 1 to 7 cm
in greatest diameter.
Normal voided urine

Umbrellas and squames
Melamed Wolinska bodies
Seen in degenerated urothelial cells
Even the small basal urothelial cells, because of their
scant cytoplasm and dark nuclei, are also occasionally
mistaken for carcinoma cells.

These cells are rare in voided urine but common in catheterized specimens and usually tightly clustered. Higher magnification reveals predominantly round, regular nuclear contours.
Ileal loop specimen
Most cells in ileal loop specimens are degenerated intestinal cells that resemble macrophages
Michaelis Gutman bodies
PAS, CALCIUM, IRON POSITIVE
Malakoplakia (chronic granulomatous disease)
Histiocytic inclusions
6 features of HG urothelial ca?
1. Large nuclei
2. Scant cytoplasm
3. Coarse chromatin
4. Irregular nuclear contours
5. Single cells
6. Hyperchromasia
Need all

Can have all BUT coarse chromatin in stones
Polyomavirus (JC, BK (papovaviruses))
Glassy nuclear inclusions
Decoy cells (have smooth outlines)
no clin sig
High grade uroth ca

Numerous isolated malignant cells have enlarged, dark nuclei and an increased nuclear-to-cytoplasmic ratio.
Low-grade uroth ca

Homogeneous cytoplasm, an increased nuclear-to-cytoplasmic ratio, and irregular nuclear outlines are associated with low-grade lesions, but are not specific.
Benign stone atypia
Benign
malignant - HGUC
Schistosoma haemotobium
Nile River Valley
Causes SCC bladder

egg has terminal spine
Adenoca of the bladder is rare and associated with what?
Bladder exstrophy & urachal remnants
FISH for uroth ca?
9- (deletion p16. Earliest!)
3+ 7+ 17+
Mesothelial cell markers
Calretinin
CA125
CD44
CK5/6
D240
WT1
pleural effusion
pleural effusion
Causes of eosinophilic

#1: pneumothorax! vs idiopathic

drug, parasite, infarction,
DDx lymphocytic pleural effusion
Malignancy
Tb
CABG
Pleural effusion
Pleural effusion
Rheumatoid pleuritis

Abundant granular material in irregular clumps
Macrophages, can be spindly
Lack of mesos
Pleural effusion
Pleural effusion
Lupus cell!
a neutrophil or macrophage that contains an
ingested cytoplasmic particle called a hematoxylin body, that pushes the nucleus to one side
#1 malignant pleural effusion in males? females?

Peritoneal?
Pleural: M: LUNG, lymphoma; F: BREAST, lung

Peritoneal: M: lymphoma, GI; F: OV, breast
Malignant mesothelioma

Many large groups, knobby edges
Round central nuclei

OFTEN HAVE A NORMAL N:C RATIO
Malignant mesothelioma

Many large groups, knobby edges
Round central nuclei

OFTEN HAVE A NORMAL N:C RATIO
What virus is associated with this?
What virus is associated with this?
Primary effusion lymphoma
HHV8, often co-infected with EBV

Seen in HIV pts. Poor px.
Rare subtype DLBCL. CD45+
pleural fluid
pleural fluid
Metastatic breast ca

Cannonball appearance
Peritoneal washing
Peritoneal washing
Endometriosis
Peritoneal washing
Peritoneal washing
Reactive mesothelial cell in response to chemo

Very large
Plasma cells in CSF are associated with:
Plasma cells in CSF are associated with:
• viral meningitis (e.g., enterovirus, human immunodeficiency
virus [HIV])
• Lyme disease (IMAGE)
• tuberculosis
• cysticercosis
• syphilis
• multiple sclerosis
Macrophages in CSF are associated with:
Macrophages in CSF are associated with:
• meningitis
• subarachnoid hemorrhage (IMAGE)
• intraventricular hemorrhage
• cerebral infarction
• post-treatment inflammation
• multiple sclerosis
Neutrophils in CSF are associated with:
• peripheral blood contamination
• acute bacterial meningitis
• CMV radiculopathy
• Toxoplasma meningoencephalitis
• viral meningitis (early stage)
Eosinophils in CSF are associated with:
• parasites
• Coccidioides immitis
• ventriculoperitoneal shunts
• Rocky Mountain spotted fever
cysticercosis
CSF
recurring attacks of fever, headache, and neck
stiffness. Symptoms appear suddenly, last for 5 to 7 days, resolve spontaneously, but recur days or years later.
CSF
recurring attacks of fever, headache, and neck
stiffness. Symptoms appear suddenly, last for 5 to 7 days, resolve spontaneously, but recur days or years later.
Mollaret meningitis, form of aseptic meningitis
(aka idiopathic recurrent meningitis)

“Mollaret cells,” monocytes with deep nuclear clefts that impart a footprint-like appearance to the nucleus, are seen within the first 24 hours of the onset of symptoms. They are characteristic of but not specific for MM; they can be seen in other diseases like sarcoidosis and Behçet disease
In CSF, when do T cells predominate? B cells?
T cells - viral meningitis
B cells - Lyme
CSF, Pap stain
CSF, Pap stain
Cryptococcus

• round yeast forms
• variable size: 5 to 15 μm diameter
• pink or purple (Papanicolaou stain)
• asymmetric, narrow-based budding
• mucin-positive capsule
• refractile artifact
Toxoplasmosis

Neutrophils, monos, tachyzoites
Cysticercosis

Taenia solium

Numerous thin walled cysts in the brain

20-70% eos
#1 cause of eosinophilic meningitis in Asia?
Angiostrongyliasis

Nematode (roundworm)

Does not show discrete lesions on imaging (vs cysticercosis)
CSF Ameba?
Naegleria fowleri

Primary amebic meningoencephalitis must be distinguished from an amebic brain abscess caused by Entamoeba histolytica. Amebae are not seen in the CSF with the latter infection.
Primary CNS lymphoma

EBV+ in immunocompromised patients
Cerebellar mass, kid
Cerebellar mass, kid
Medulloblastoma

MOLDING
Small round blue cells

Pineoblastomas look exactly like this. These tumors are in kids, and located in the pineal gland.
Medulloblastoma

MOLDING
Small round blue cells

Pineoblastomas look exactly like this. These tumors are in kids, and located in the pineal gland.
csf
csf
GBM
csf adolescent with 4th ventricle mass
csf adolescent with 4th ventricle mass
ependymoma
round eccentric nuclei
Infant
Infant
Atypical Teratoid/Rhabdoid Tumor (ATRT)
rhabdoid cells:
medium-sized to large-sized cells with a round, eccentrically placed nucleus, and a prominent nucleolus. The cytoplasm is homogeneous and may contain a large, poorly defined, dense, inclusion-like structure that pushes aside the nucleus
Child, 4th ventricle mass
Child, 4th ventricle mass
Choroid plexus papilloma
Tumor cells are arranged in large, three-dimensional clusters of uniform cuboidal cells with a round or oval nucleus

**Choroid plexus carcinomas are rare and exclusively in children**
CNS, pineal mass
CNS, pineal mass
Germinoma

Any germ cell tumor can occur in the pineal/suprasellar region. Germinomas are the most common, occurring more often in males, and in young adults
esophageal brushing
esophageal brushing
HSV
esophageal specimen
esophageal specimen
radiation change

Cellular and nuclear enlargement, multinucleation,
and vacuolization of cytoplasm and nuclei are characteristic
esophagus
esophagus
Low grade dysplasia in background of Barrett's
esophagus
esophagus
adenoca

Features favoring ca over HGD:
More cells & more atypia (quantitative rather than qualitative)
tumor diathesis
Esophageal mass
Esophageal mass
Leiomyoma
gastric brushing
gastric brushing
signet ring cell carcinoma

(in contrast to goblet cells, nuclei are hyperchromatic and angulated)
duodenal brushing
duodenal brushing
well-differentiated endocrine (carcinoid) tumor
Gastric FNA
Gastric FNA
GIST
ckit+ (DOT-LIKE CYTOPLASMIC)
Duodenum
Duodenum
Microsporidium
obligate intracellular spore-forming protozoon
AIDS
Bright red on Pap; 1-3um
Duodenum
Duodenum
Cryptosporidium
2-5um
HIV
luminal surface
Ampullary brushing
Ampullary brushing
Adenoma
A crowded group of glandular cells with mucin depletion and an increased nuclear-to-cytoplasmic ratio is present. A gland opening is apparent. Despite the crowding, the arrangement is orderly. The nuclei are enlarged and elongated but significant atypia is absent
Colon
Colon
TA
A cohesive group of stratified but orderly glandular cells with elongated nuclei is seen. Despite the increased nuclear-to-cytoplasmic ratio and hyperchromasia, significant atypia is absent
Nipple discharge
Nipple discharge
Benign
Histiocytes/ foam cells
Ductal lavage
Ductal lavage
Benign ductal cells with MYOEPS
Breast
Breast
Apocrine metaplasia

Large, flat sheets of apocrine cells have distinct cytoplasmic borders, a centrally located nucleus,
and a prominent nucleolus. Abundant granular cytoplasm is gray-purple
Apocrine metaplasia

Large, flat sheets of apocrine cells have distinct cytoplasmic borders, a centrally located nucleus,
and a prominent nucleolus. Abundant granular cytoplasm is gray-purple
Breast
Breast
Benign ductal cells

Note the interspersed myoepithelial cells, which stand out like sesame seeds on a bun
Breast
Breast
DCIS / suspicious for malignancy

The cells are loosely cohesive with marked nuclear pleomorphism, nucleoli, and a dirty background. Such specimens cannot be distinguished from invasive carcinoma
Breast
Breast
Fibroadenoma

Hypercellular with folded sheets and many ANTLER-HORN CLUSTERS

May have stripped nuclei
breast
breast
FA
breast
breast
FA!

Note the prominent nuclear atypia with nucleoli. The tightness of the cluster and a background of single bipolar cells and stripped nuclei are important clues in avoiding an overdiagnosis of malignancy

IDC has ISOLATED CELLS WITH INTACT CYTOPLASM
Breast
Breast
Lactational change/ pregnancy

Numerous isolated epithelial cells or stripped nuclei
Prominent nucleolus
Wispy granular vacuolated cytoplasm
Proteinaceous background
Breast
Breast
Fat necrosis

Histiocytes with foamy vacuolated cytoplasm and oval nuclei
Breast
Breast
Radiation change

pronounced nuclear enlargement but also concomitant cytomegaly. The nuclear to cytoplasmic ratio is maintained
breast
breast
cancer

in contrast to previous, the nuclei are irregular
and the nuclear-to-cytoplasmic ratio is increased
Male breast
Male breast
Gynecomastia

Identical to FA
Breast
Breast
"Papillary lesion"
Can't tell benign from malignant on cytology
 3D sheets, usually bloody, usually central

vs. FA: Papillary lesions are DYSHESIVE at edges
"Papillary lesion"
Can't tell benign from malignant on cytology
3D sheets, usually bloody, usually central

vs. FA: Papillary lesions are DYSHESIVE at edges
Breast
Breast
Phyllodes tumor

Similar to FA but MORE cellular
Phyllodes tumor

Similar to FA but MORE cellular
Breast
Breast
IDC / DCIS (can't tell on cytology)

HYPERCELLULAR
isolated cells and poorly cohesive clusters of cells
eccentric nucleus often protruding from the cytoplasm (i.e., “comet cells”)

**ISOLATED CELLS
Breast
Breast
COMET CELL!

IDC!
breast
breast
ILC

Sparsely cellular
small to medium sized cells
intracytoplasmic vacuoles
Single filing
Hyperchromatic kidney bean nucleus
Breast in young patient
Breast in young patient
Medullary carcinoma

Well-circumscribed mass
Numerous isolated cells
Mitoses
Abundant lymphs and plasma cells
Breast
Breast
Mucinous / colloid carcinoma

Excellent prognosis

Tightly cohesive 3D balls of cells
Mucinous background
BRANCHING CAPILLARIES
Mucinous / colloid carcinoma

Excellent prognosis

Tightly cohesive 3D balls of cells
Mucinous background
BRANCHING CAPILLARIES
Breast
Breast
Tubular carcinoma
Excellent prognosis
Mimics FA
Clusters of cells typically come to a sharp point (comma or cornucopia formations). By contrast, fibroadenomas (FAs) tend to have more rounded and
less rigid outlines.
The presence of angular epithelial groups, isolated epithelial cells, and nuclear atypia, warrants consideration of the diagnosis of TC
Breast
Breast
Apocrine carcinoma
Rare subtype
Granular cytoplasm
Necrotic debris
Protruding nuclei
Variation in nuclear size but not much atypia
Breast
Breast
Adenoid cystic carcinoma

Hyaline globules (also seen in collagenous spherulosis)
Adenoid cystic board pearls
COLLAGEN IV stains background

p63 stains tumor cells. the only breast malignancy with myoepithelial cells!

Excellent prognosis in breast, as opposed to poor px in salivary gland
Ferruginous body

ASBESTOSIS
Aspergillus fumigatus

Associated with CALCIUM OXALATE crytstals
Characteristics of TB effusions
Yellow turbid fluid
Abundant lymphs (in clusters!)
Few mesos

UNCOMMON to see MNGCs
Central lung mass
Scc
Small cell ca
Herxheimer spirals
Marker of squamous diff
Long thin strands of keratin
Benign or malignant