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Dr. Shameem Shariff, MD, PhD
Formerly, Professor and Head,
Dept. of Pathology, MVJ Medical College and Research Hospital &
St. John's Medical College,
Bengaluru, India
www.shameempathology.com/

Tell me and I forget. Teach me and I remember. Involve me and I learn. - Benjamin Franklin

HISTO-PATHOLOGY

Section from a bone lesion in a 20 year old male . Make your diagnosis from the section shown below. What characters in the photomicrograph enable your diagnosis. List the variants of the lesion and their favoured sites of occurrence. What factors predispose to this condition?.

Ans to previous : (March 2024) Fig 1 : is epidermoid cyst; fig 2 is trichilemmal sebacceous cyst; and fig 3 is dermoid cyst. The first one is lined by epidermis and filled with laminated keratin; the second by stratified epithelium devoid of a granular cell layer (outer root sheath layer) and filled by homogenous keratin and the third shows a dermoid cyst. Dermoid cysts are derived from the ectoderm and involve embryologic closure lines. These are subcutaneous cysts and the lining is typically a keratinising squamous epithelium. The hallmark of these cysts is the presence of pilosebaceous structures (skin appendages) in the cyst wall.

CYTO-PATHOLOGY

Aspirate from a mass at the lower end of humerus, in a 18 year old male patient. Smears for diagnosis. Fig 1 : Cellular aspirate showing cells against a haemorrhagic background. Fig 2 : smear shows spindle shaped cells, tumour giant cell and some amorphous material and haemorrhage in the background.

Ans to previous (March 2024): This is a cell block preparation on aspirated material. Shows actinomycotic colony surrounded by neutrophils. A eosinophilic stained zone is seen around the colony (seen in the fig) at times and is called the Splendore-Hoeplli phenomenon. Splendore-Hoeppli phenomenon is characterized by microorganisms (fungi, bacteria and parasites) resulting in a radiating intensely eosinophilic material. This is due to deposition of antigen-antibody complexes and debris from the host inflammatory cells.

TECHNIQUES

What is decalcification? Name some decalcifying agents used in the laboratory. What are the adverse effects of decalcification?

Ans to previous (March 2024): Progressive staining is to continue staining (increasing nuclear or cytoplasmic selectivity ) till the desired effect is reached, then washing off the stain. Eg Romanowsky's stain. Regressive staining is to overstain and then remove the excess stain using differentiators like acid, ethyl alcohol etc. The excess stain is removed till the right intensity is reached eg haematoxylin staining followed by differentiation by acid alcohol.

MCQ

Choose the best answer: Stem Cells are : 1. Bone marrow cells 2. Undifferentiated cells which have the ability to differentiate to specific morphological types 3. Can regenerate when required 4. Are classified as labile cells	Ans to previous (March 2024) Ans is (2) Clinical manifestations include irregular vaginal bleeding and post -menopausal bleeding and rarely hirsutism and acne.

"Live as if you were to die tomorrow. Learn as if you were to live forever." - Mahatma Gandhi

HISTO-PATHOLOGY

Make your diagnosis in the sections shown below : Fig 1, 2 and 3 belonging to different cases and are cysts arising from the skin. How do you differentiate each histologically? Fig 1A Fig 1B Fig 2 Fig 3	Ans to previous : (Feb 2024) This is a section from mammary tissue showing cystically dilated ducts in a lobule and apocrine metaplasia of the lining cells.

CYTO-PATHOLOGY

What do you see in the section shown? What is Splendore-Hoeplli phenomenon?	Ans to previous (Feb 2024): The aspirate shows cells with round nuclei, basophilic cytoplasm and prominent cytoplasmic vacuoles. This appearance is highly suggestive of a Burkitt's lymphoma. On subsequent testing the patient was positive for c-myc translocation.

TECHNIQUES

What is progressive staining and regressive staining?	Ans to previous (Feb 2024): Factors on which frozen section cutting is dependent : Atmospheric humidity; Temperature of cryostat at which tissue is cut; Fixation of the tissue; Type of tissue.

MCQ

Choose the best answer: The following is true of adult granulosa cell tumour : 1. Granulosa cell tumour is a benign stromal neoplasm of the ovary. 2. Clinical manifestations include irregular vaginal bleeding and post -menopausal bleeding and rarely hirsutism and acne. 3. Adjuvant chemotherapy has a controversial role. 4. Juvenile granulosa cell tumours are more common than adult GCT	Ans to previous (Feb 2024) Ans is ( a.) represents Homer-Wright rosettes named after James Homer Wright, the first director of the Massachusetts General Hospital and seen in neuroblastomas, medulloblastomas, and primitive neuroectodermal tumours (PNETs). Note : Rosettes are so named for their resemblance to the rose windows found in gothic cathedrals.

The secret of getting ahead is getting started - Mark Twain

HISTO-PATHOLOGY

Can you identify the tissue? What is the change shown in the above section?	Ans to previous : (JAN 2024) Chondroid syringoma (Cutaneous pleomorphic adenoma. Note plasmacytoid differentiation of cells in fig 3)

CYTO-PATHOLOGY

Make your diagnosis from the FN aspirate of an adenoid swelling in an 18 year old male patient.	Ans to previous (JAN 2024): Adenoid cystic carcinoma lung. A rare tumour primary in lung. Seen also in salivary glands, lacrimal glands , trachea etc

TECHNIQUES

On what factors is 'frozen section cutting' dependent ?	Ans to previous (JAN 2024): Whole slide imaging. Used for interpretation in digital pathology. Approved by FDA for primary diagnosis in histopathology.

MCQ

Choose the best answer: Which of the following is typical of a 'Homer-Wright rosette'? a. Centre has no lumen, but abundant fibrillary material as occurs in a neuroblastoma b. Contain clearly delineated empty central lumen /canal around which cells are arranged as occurs in retinoblastoma. c. Cells are arranged around a blood vessel: pseudo-rosettes as seen in Ewing's sarcoma d. Attempts by the tumour cells to recreate little ventricles with ependymal lining as seen in ependymoma.

Ans to previous (JAN 2024) ANS is B: Yellow.

"Live as if you were to die tomorrow. Learn as if you were to live forever." - Mahatma Gandhi

HISTO-PATHOLOGY

Make your diagnosis in the sections shown below : Fig 1, 2 and 3 belonging to different cases and are cysts arising from the skin. How do you differentiate each histologically? Fig 1A Fig 1B Fig 2 Fig 3	Ans to previous : (Feb 2024) This is a section from mammary tissue showing cystically dilated ducts in a lobule and apocrine metaplasia of the lining cells.

CYTO-PATHOLOGY

What do you see in the section shown? What is Splendore-Hoeplli phenomenon?	Ans to previous (Feb 2024): The aspirate shows cells with round nuclei, basophilic cytoplasm and prominent cytoplasmic vacuoles. This appearance is highly suggestive of a Burkitt's lymphoma. On subsequent testing the patient was positive for c-myc translocation.

TECHNIQUES

What is progressive staining and regressive staining?	Ans to previous (Feb 2024): Factors on which frozen section cutting is dependent : Atmospheric humidity; Temperature of cryostat at which tissue is cut; Fixation of the tissue; Type of tissue.

MCQ

Choose the best answer: The following is true of adult granulosa cell tumour : 1. Granulosa cell tumour is a benign stromal neoplasm of the ovary. 2. Clinical manifestations include irregular vaginal bleeding and post -menopausal bleeding and rarely hirsutism and acne. 3. Adjuvant chemotherapy has a controversial role. 4. Juvenile granulosa cell tumours are more common than adult GCT	Ans to previous (Feb 2024) Ans is ( a.) represents Homer-Wright rosettes named after James Homer Wright, the first director of the Massachusetts General Hospital and seen in neuroblastomas, medulloblastomas, and primitive neuroectodermal tumours (PNETs). Note : Rosettes are so named for their resemblance to the rose windows found in gothic cathedrals.

The secret of getting ahead is getting started - Mark Twain

HISTO-PATHOLOGY

Can you identify the tissue? What is the change shown in the above section?	Ans to previous : (JAN 2024) Chondroid syringoma (Cutaneous pleomorphic adenoma. Note plasmacytoid differentiation of cells in fig 3)

CYTO-PATHOLOGY

Make your diagnosis from the FN aspirate of an adenoid swelling in an 18 year old male patient.	Ans to previous (JAN 2024): Adenoid cystic carcinoma lung. A rare tumour primary in lung. Seen also in salivary glands, lacrimal glands , trachea etc

TECHNIQUES

On what factors is 'frozen section cutting' dependent ?	Ans to previous (JAN 2024): Whole slide imaging. Used for interpretation in digital pathology. Approved by FDA for primary diagnosis in histopathology.

MCQ

Choose the best answer: Which of the following is typical of a 'Homer-Wright rosette'? a. Centre has no lumen, but abundant fibrillary material as occurs in a neuroblastoma b. Contain clearly delineated empty central lumen /canal around which cells are arranged as occurs in retinoblastoma. c. Cells are arranged around a blood vessel: pseudo-rosettes as seen in Ewing's sarcoma d. Attempts by the tumour cells to recreate little ventricles with ependymal lining as seen in ependymoma.

Ans to previous (JAN 2024) ANS is B: Yellow.

This is a New Year. A new beginning. And things will change !

HISTO-PATHOLOGY

A subcutaneous mass on the cheek of a 45 year old male. : Excised and histopathology shown. Make your diagnosis. Fig 1 H&E x 25 Fig 2 H&E x 100 Fig 3 H&E x 400	Ans to previous : (DEC 2023) Sarcomatoid dedifferentiation in renal cell carcinoma.

CYTO-PATHOLOGY

Aspirate from a centrally located lesion in the lung of a 60 year old male. Aspirate done at bronchoscopy. H & E 100 Giemsa x 25	Ans to previous (DEC 2023): FNAC shows cysticercus cellulosae . Advised simple excision of the lesion. Histology of excised mass shown below. Arrows point to site representing aspirated material.

TECHNIQUES

What do you understand by the term 'WSI' ? What is it's importance ? Is it approved for a primary pathology diagnosis ?	Ans to previous (DEC 2023): Testing for activity of Schiff reagent. Pour few drops of Schiff reagent into 10 ml of concentrated formalin. If the reagent is active, the solution turns reddish pink rapidly. If the blue color develops after some time, the solution is breaking down.

MCQ

Choose the best answer: What is the colour of Pol Boiun's fixative? A. Amber B. Yellow C. Colourless D. Pale pink	Ans to previous (DEC 2023) ANS is B. ie. Pre-apoptotic crippled germinal center B lymphocyte.

DECEMBER 2023

The Secret of your future is hidden in your daily routine.

HISTO-PATHOLOGY

Mass in the kidney of a 66 year old male. Two representative sections are shown. Make your diagnosis.	Ans to previous : (NOV 2023) Secretary carcinoma breast ( less than 1% of carcinomas ). Chromosomal translocation: t (12;15) (p13; q25); leads to the formation of the ETV6-NTRK3 fusion gene & is diagnostic. It is triple negative but mimics the immune characteristics of hormone receptor-positive cancer rather than TNBC. Targeting the ETV6-NTRK3 fusion gene is the major focus of current therapy.

CYTO-PATHOLOGY

A 2 cm nodule on the anterior aspect of thigh. Aspiration performed. Make your diagnosis. What advice would you give post FNA to confirm the diagnosis? H & E 250 Giemsa x 400	Ans to previous (Nov 2023): Subacute granulomatous thyroiditis, a self-limited thyroiditis. It is preceded by an upper respiratory tract infection such as mumps, measles, coxsackie virus, adenovirus, and influenza viruses. Necrosis and several giant cells are diagnostic at FNA.

TECHNIQUES

How do you test for the efficacy of PAS stain?	Ans to previous (Nov 2023): At 4-5 microns. Frozen sections : Optimal thickness is 4 - 7 microns; but in most places cut at 7-8 microns. IHC sections- Depends on storage of tissue. 4-6 microns on paraffin embedded tissue and 12- 30 microns on frozen tissue sections.

MCQ

Choose the best answer: The R-S cells of Hodgkin's lymphoma usually arises from : A. Mature T cells B. Pre-apoptotic B cells C. Histiocyte D. Dendritic cell	Ans to previous (Nov 2023) A: Morphological appearances of a neoplasm in the thyroid gland. Orphan Annie-eye nuclei in HP has large nuclei, molded with singular membranes, nuclear clearing with powdery chromatin & nuclear grooves . It is so named after the American comic character "Little Orphan Annie" by James Whitcomb Riley, the white of the eyes resembling the nuclei.

And not by eastern windows only,
When daylight comes, comes in the light,
In front the sun climbs slow, how slowly,
But westward, look, the land is bright.
(From : Say not the Struggle nought Availeth by ARTHUR HUGH CLOUGH)

HISTO-PATHOLOGY

Section from mass in the left breast of a 34 year old female. Make your diagnosis. What are the characteristics of this neoplasm? H&E x 400	Ans to previous : (OCT 2023) Radial scar (< I cm)/Complex sclerosing lesion (>1cm) - breast. Fibro-elastotic centre with radiating epithelial ducts some showing cystic change. Is often mistaken for invasive carcinoma breast on imaging and sometimes at histology. associated with DCIS

CYTO-PATHOLOGY

A 45 year old female presented with thyroid gland enlargement of one week's duration. On examination, thyroid gland showed diffuse enlargement. Besides this the patient gave a history of cough and mild fever of 15 days duration. Images for diagnosis from FNAC on the thyroid. Make your diagnosis. Pap x 25 Pap x 400 Giemsa x 100	Ans to previous : FNAC shows metastatic adenocarcinoma abdominal wall (sister Mary Joseph's nodule). Signet ring type cells are seen. PAS stain; AB-PAS.

TECHNIQUES

At what thickness are routine paraffin sections cut? And at what thickness are frozen sections and sections for Immuno-histochemistry cut?	Ans to previous : Grid for grossing of malignant bone tumours (osteogenic sarcoma, Ewing's sarcoma ) to assess response to chemotherapy

MCQ

Choose the best answer: Orphan Anne eyes are characteristic of : A. Morphological appearances of a neoplasm in the thyroid gland B. Hodgkin's Lymphoma C. Granulosa cell tumour of ovary D. Glycogen clearing of nuclei in liver Why is it so named?	Ans to previous A: Aneurysmal bone cyst.

"You don't learn to walk by following rules. You learn by doing, and by falling over" - Richard Branson

	What is this lesion in the breast called? What is it mistaken for mammographically? What is it's significance?

CYTO-PATHOLOGY

	This is an FNAC picture of an aspirate done on an abdominal wall nodule in a 65 year old female. What is your diagnosis? Give reasons. Which histochemical stain will help?

TECHNIQUES

	What is this grid? When is grossing done with this grid and why?

MCQ Choose the best answer: Telangiectatic osteogenic sarcoma is usually mistaken clinically and at imaging for : A. Aneurysmal bone cyst B. Solitary bone cyst C. Haem-arthrosis D. All of the above