Pathology Notes

Practice question III answers Pathology of thyroid ©Jun Wang, MD, PhD   1. B. This lesion is characterized by capsulated nodular growth of packed small follicles with normal appearing follicular cells. This can be either follicular adenoma , if no invasion can be seen, or follicular carcinoma , if vascular or capsular invasion is seen. Capsular invasion is seen in this case, characterized by capsule disconnected due to follicular tissue. Hashimoto thyroiditis is characterized by follicular destruction in a background of diffuse polyclonal lymphoid infiltrate, with or without lymphoid follicle formation. Multinodular goiter is characterized by unevenly benign enlargement of thyroid with nodular growth pattern and follicles markedly various in size. Papillary thyroid carcinoma , including follicular variant, is diagnosed based on typical nuclear features, such as enlarged nuclei, washed out chromatin, nuclear grooves or inclusion. 2. B. PAX8, PTEN and RAS/PI3KCA mutation can

Practice question III Pathology of thyroid © Jun Wang, MD, PhD   1. Use this case and image for the next three questions . A 54-year-old woman presents with hoarseness for 3 months. She denies other symptoms. Her past medical history is unremarkable. She has a 30 pack-year history of cigarette smoking and is a social drinker. She denies usage of illicit drugs. Physical examination reveals left vocal cord paralysis. The mucosa of her vocal cords are unremarkable. No other abnormalities are seen. Laboratory tests are all within normal ranges. Sonographic examination reveals a 2.5 cm mass at the lower posterior portion of her left thyroid. Fine needle aspiration reveals small clusters of follicular cells without significant cytological atypia. Partial thyroidectomy was performed. An image of the microscopic findings is shown. No nuclear enlargement, nuclear inclusion or grooves are seen. What is the diagnosis? (Image credit: Nephron [CC BY-SA 4.0 (https://creativecommons.org/licens

Practice question III answers Lung and pleural tumors © Jun Wang, MD, PhD   1. B. Malignant tumors composed of irregular glands lined by atypical cells are adenocarcinoma s . Abscess is characterized by collection of neutrophils and other inflammatory cells in a necrotic background, but do not have glandular growth. Metastatic renal cell carcinoma does not have glandular pattern and is negative for TTF-1. Small cell carcinoma has solid nests of cells with round to oval molding nuclei and scant cytoplasm. Squamous cell carcinoma has squamous differentiation characterized by intercellular bridges and keratin pearls . 2. D. TTF-1 is usually positive in adenocarcinomas of lung. Calretinin and WT-1 are positive for mesothelioma . Chromogranin is a neuroendocrine marker that is expressed in neuroendocrine tumors, including carcinoid , small cell carcinoma , and olfactory neuroblastoma . P63 is a marker for squamous cell differentiation and is positive for squamous cell carcinom

Practice questions III Lung and pleural tumors © Jun Wang, MD, PhD   1. Use this case and this image for next three questions . A 75-year-old woman presents with non-productive cough and a 15 lb weight loss in the past 6 months. She does not have fever or chest pain. She has a history of clear cell type renal cell carcinoma at age 57 and was treated with left nephrectomy. Her past medical history is otherwise unremarkable. She does not smoke cigarette nor drink alcohol. Radiologic examination reveals a 2.5 cm lesion in the right middle lobe. An image of the biopsy is shown. There are foci of necrosis with neutrophils. What is most likely the diagnosis?     ( Image credit: Yale Rosen from USA, CC BY-SA 2.0 <https://creativecommons.org/licenses/by-sa/2.0>, via Wikimedia Commons)   A. Abscess B. Adenocarcinoma C. Metastatic renal cell carcinoma D. Small cell carcinoma E. Squamous cell carcinoma   2. A 75-year-old woman presents with non-productive cough and a 15 lb weight