Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/74

Click to flip

74 Cards in this Set

  • Front
  • Back
  • 3rd side (hint)
Amylase, lipase, leuk esterase in pseudocyst? Neoplastic?

Tumor markers in mucinous cyst?
all high in psuedocyst.
all low in neoplastic cyst.

Mucinous cyst has elevated ***CEA, CA19.9, CA125, CA15.3

IPMN can have elevated amylase. LOW LEVEL excludes pseudocyst
Pancreas FNA
Pancreas FNA
Normal acini

Acinar arrangement
Eccentric round nucleus
Even chromatin, no necleolus
Granular cytoplasm
Indistinct cell borders
Pancreas FNA
Pancreas FNA
Normal ductal cells

Flat cohesive sheets
Even nuclear spacing, round nuclei
Fine chromatin
No nucleolus
Distinct borders
Normal ductal cells

Flat cohesive sheets
Even nuclear spacing, round nuclei
Fine chromatin
No nucleolus
Distinct borders
Pancreas
Pancreas
Chronic pancreatitis

Enlarged ROUND nuclei with overlapping
PROMINENT NUCLEOLI

Reactive conditions + for SMAD4, - p53 (vs adenoca)
Chronic pancreatitis

Enlarged ROUND nuclei with overlapping
PROMINENT NUCLEOLI

Reactive conditions + for SMAD4, - p53 (vs adenoca)
Pancreas mass head
Pancreas mass head
Ductal adenoca
80% in head of pancreas

Cellular, crowded, disordered (DRUNKEN HONEYCOMB)
ISOLATED CELLS
Irregular nuc contours, enlargement, irregular chromatin, mitoses
ANISONUCLEOSIS (4xdifferences in size)
Prominent nucleoli
Ductal adenoca
80% in head of pancreas

Cellular, crowded, disordered (DRUNKEN HONEYCOMB)
ISOLATED CELLS
Irregular nuc contours, enlargement, irregular chromatin, mitoses
ANISONUCLEOSIS (4xdifferences in size)
Prominent nucleoli
IHC of pancreatic ductal adenoca vs chronic pancreatitis vs normal GI epithelium
ca: +p53/-SMAD4/-CDX2
itis: -p53/+SMAD4/-CDX2
GI: -p53/+SMAD4/+CDX2
Pancreas
Pancreas
Adenosquamous carcinoma
Variant of ductal adeno
Must have >30% squamous
Pancreas mass
Pancreas mass
Undifferentiated (anaplastic) carcinoma
var of ductal adeno
Highly cellular smears, pleomorphic cells
Osteoclast like GIANT CELLS
PHAGOCYTOSIS OF INFLAM CELLS & RBCs

r/o mets
Undifferentiated (anaplastic) carcinoma
var of ductal adeno
Highly cellular smears, pleomorphic cells
Osteoclast like GIANT CELLS
PHAGOCYTOSIS OF INFLAM CELLS & RBCs

r/o mets
Pancreas
Pancreas
Acinar cell carcinoma

Poor prognosis

Can look like benign acinar cells: usually LARGE nuclei and prominent nucleolus, with crowding. and has ISOLATED cells

Can look like PEN & this is a harder distinction (both are dyshesive). Need IHC: both keratin+
ACC: trypsin, chymotrypsin, lipase
PEN: chromo/synapto
Acinic cell ca

Dense zymogen granules
pancreas 35y F

IHC?
pancreas 35y F

IHC?
Solid pseudopapillary neoplasm
Uncertain malignany potential
No preference for pancreatic site
Young women

Highly cellular
Hyalinized vascular stalks lined by neoplastic cells
Cells not very pleomorphic; small; occasional grooves

IHC+: a1aT, PR
Solid pseudopapillary neoplasm
Uncertain malignany potential
TAIL
Young women

Highly cellular
Hyalinized vascular stalks lined by neoplastic cells
Cells not very pleomorphic; small; occasional grooves

IHC?
(+)
a1aT
PR
CD56
CD10
ckit.
NUCLEAR BETA CATENIN+
APC gene

usually negative/wk for keratins (ACC) & synapto (PEN)
2 cm well-circumscribed pancreatic partially cystic mass
2 cm well-circumscribed pancreatic partially cystic mass
PEN (Pancreatic endocrine neoplasm)
Most secrete hormone (insulin, glucagon, somatostatin, VIP, serotonin, ACTH, calcitonin)

Most are well-diff
Predominantly ISOLATED cells, BARE NUCLEI
PSEUDOROSETTES
Uniform nuclei, stippled chromatin

+chromo &
PEN (Pancreatic endocrine neoplasm)
Most secrete hormone (insulin, glucagon, somatostatin, VIP, serotonin, ACTH, calcitonin)

Most are well-diff
Predominantly ISOLATED cells, BARE NUCLEI
PSEUDOROSETTES
Uniform nuclei, stippled chromatin

+chromo & synapto
Well-diff vs poorly diff endocrine neoplasms
Poorly diff are uncommon; divided into 2 types:
-Small cell carcinoma
-Large cell endocrine carcinoma
Characterized by marked mitoses (>10/10hpf)
Pancreatic mass 66F
Characteristic location?
Pancreatic mass 66F
Characteristic location?
Serous cystadenoma

BODY & TAIL

Cytology: sparse cells in clean background
flat sheets cuboidal cells, PAS+ glycogen in granular cytoplasm, bare nuc, small round nuc
Pancreatic mass 50F

Location?
Pancreatic mass 50F

Location?
Mucinous cystic neoplasm
5% pancreatic tumors
Found only in women
BODY & TAIL
Mucinous epithelium
does NOT connect to ductal system
OVARIAN TYPE STROMA
Can be b9, borderline, or malignant
Mucinous cystic neoplasm
5% pancreatic tumors
Found only in women
BODY & TAIL
Mucinous epithelium
does NOT connect to ductal system
OVARIAN TYPE STROMA
Can be b9, borderline, or malignant
Pancreatic mass
Clinical features?
Location?
Most important prognostic feature?
Pancreatic mass
Clinical features?
Location?
Most important prognostic feature?
IPMN!
3-5% pancreatic tumors
M>F!
HEAD OF PANCREAS
GROWS ALONG PANCREATIC DUCTS
Can be b9, borderline, or malignant
Most important px feature is lack of invasion

(Cytology cannot distinguish MCN/IPMN)
Most common mets to pancreas?
Lung (small cell and SCC)
Breast
Kidney
Lymphoma
Kidney FNA
Kidney FNA
Normal glomerulus
-large dense globular structures with capillary loops

(DDX: LG Papillary RCC but cells in gloms are NOT evenly distributed - denser in ctr - with periph capillary loops)
Kidney
Kidney
Proximal tubular cells
-Rare cells with round bland nucleus
- Small prominent nucleolus
-Abundant granular cytoplasm (granules look like they are spilling out of cytoplasm)
- Lack cell borders

DDx: Oncocytoma, chromophobe (but these are more cellular, frequently BINUCLEATED, variation in size, WELL DEFINED borders)
Kidney
Kidney
Distal tubular cells
-Rare cells, scant granular cytoplasm

DDx: LG clear cell or papillary RCC (more cellular)
Kidney FNA
Kidney FNA

IHC?
Oncocytoma
• highly cellular
• rounded nests (cell block)
• cohesive fragments and dyshesive cells (smears)
• abundant uniformly granular cytoplasm
• Fuhrman grade 2 nucleoli

r/o hepatocytes (lipofuscin)
r/o RCC (more cohesive, more atypia)
r/o
Oncocytoma
• highly cellular
• rounded nests (cell block)
• cohesive fragments and dyshesive cells (smears)
• abundant uniformly granular cytoplasm
• Fuhrman grade 2 nucleoli

r/o hepatocytes (lipofuscin)
r/o RCC (more cohesive, more atypia)
r/o chromophobe (less uniformly granular. Very hard to ddx! oncocytoma nested vs trabeculae of chromophobe. Hales diffuse+)

EM?
Abundant mitochondria
Abundant mitochondria
Renal cortical adenoma vs LG papillary RCC?
Identical except RCA < 0.5cm
Kidney FNA

Types?
Variant?
Kidney FNA

Types?
Variant?
Angiomyolipoma
Benign PEComa
Fat (scant on FNA), vessels, smooth muscle (may be atypical)
1. Young adults with TS (multiple & bilateral)
2. Middle age women (solitary)

Epithelioid AML resembles ganglion cells, can have mits & necrosis

IHC?
Angiomyolipoma
Benign PEComa
Fat (scant on FNA), vessels, smooth muscle (may be atypical)
1. Young adults with TS (multiple & bilateral)
2. Middle age women (solitary)

Epithelioid AML resembles ganglion cells, can have mits & necrosis

IHC?
HMB45+
MART1+
HMB45+
MART1+
Kidney FNA 50F
Kidney FNA 50F
Metanephric adenoma
rare benign
Tight uniform tubules lined with bland cells with small round nuclei
PSAMMOMA BODIES

~pap RCC (but are EMA-)
~WT (both WT1+ but WT is triphasic)
Metanephric adenoma
rare benign
Tight uniform tubules lined with bland cells with small round nuclei
PSAMMOMA BODIES

~pap RCC (but are EMA-)
~WT (both WT1+ but WT is triphasic)
Boy with renal mass, solid on imaging
Boy with renal mass, solid on imaging
Cystic nephroma
(aka mixed epithelial stromal tumor MEST, renatl EST = REST)

Occur in boys and young women
Stroma and small cysts lined by ATYPICAL EPITHELIUM (HOBNAIL)
Looks solid on imaging
mass lesion kidney
mass lesion kidney
Xanthogranulomatous pyelonephritis

Histiocytes and MNGCs
Foamy
CD68+
Xanthogranulomatous pyelonephritis

Histiocytes and MNGCs
Foamy
CD68+
What is the Bosniak system?
Classifies renal cysts by radiology
Bosniak 1: benign
Bosniak 4: malignant
B2&3: indeterminate
What's so hard about cytology of renal cysts?
• Renal cysts are common, and most are benign.
• RCC can be cystic.
• Adequate sampling of a cystic RCC is difficult.
• Some benign cysts are difficult to distinguish from
RCC:
• cysts resulting from renal failure
• adult polycystic kidney disease
• cystic nephroma
• The value of a negative diagnosis is limited.
what benign entities in the kidney can have atypical cells?
• cystic nephroma
• renal abscess: xanthogranulomatous
pyelonephritis
• renal infarct
• atypical cysts
• angiomyolipoma

Best dx clue: Hypocellular specimen
Renal mass
Renal mass

IHC?
Clear cell RCC
-large cohesive cell groups with transgressing vessels
-Abundant wispy cytoplasm with ILL-DEFINED edges
-Vacuoles
-Large round eccentric nuc
BLOODY

genetics?
Clear cell RCC
-large cohesive cell groups with transgressing vessels
-Abundant wispy cytoplasm with ILL-DEFINED edges
-Vacuoles
-Large round eccentric nuc
CAN HAVE BASEMENT MATERIAL
BLOODY

+CD10, vimentin, RCC

genetics?
3p-
(VHL gene)
renal mass
renal mass
Papillary RCC (10% RCCs)

Type 1: Fuhrman1,2. Small, scant cyt. Low grade, more common. foamy macrophages and i/cyt hemosiderin

Type 2: Large cells abundant granular cyt. Large nuc, prom nucleoli (F3)

Note large sphere in 1st image, characteristic
Papillary RCC (10% RCCs)

Type 1: Fuhrman1,2. Small, scant cyt. Low grade, more common. foamy macrophages and i/cyt hemosiderin

Type 2: Large cells abundant granular cyt. Large nuc, prom nucleoli (F3)

Note large sphere in 1st image, characteristic

IHC?
+EMA, LMWK, CK7
-34BE12, WT1
Renal mass

Genetics?
Renal mass

Genetics?
Papillary RCC
Hemosiderin in cyt

Note foamy macs stuffing papillary cores

Trisomy 7, 16, 17
Papillary RCC
Hemosiderin in cyt

Note foamy macs stuffing papillary cores

Trisomy 7, 16, 17
Hales colloidal iron. Tumor?
Hales colloidal iron. Tumor?
CHROMOPHOBE has diffuse staining. What does oncocytoma look like?
Luminal staining only.
Luminal staining only.
Kidney mass
Kidney mass
3-5% RCC
Trabeculae with abundant cytoplasm, DISTINCT BORDERS, dark chromatin, RAISINOID nuc outlines
(look like koilocytes...)
DDx: Clear cell RCC, oncocytoma
Genetics?
Chromophobe
3-5% RCC
Trabeculae with abundant cytoplasm, DISTINCT BORDERS, dark chromatin, RAISINOID nuc outlines
(look like koilocytes...)
DDx: Clear cell RCC, oncocytoma
Genetics?
Monosomies
Chromophobe
polygonal tumor cells with abundant granular cytoplasm, round nuclei and well-defined cytoplasmic membrane 

(pic) perinuclear vacuolization & multinucleation

EM?
Chromophobe

polygonal tumor cells with abundant granular cytoplasm, round nuclei and well-defined cytoplasmic membrane

(pic) perinuclear vacuolization & multinucleation

EM?
Numerous microvesicles pushing the nucleus
Numerous microvesicles pushing the nucleus
Renal mass
Renal mass
Sarcomatoid rcc
high grade spindle cell neoplasm
poor px
Sarcomatoid rcc
high grade spindle cell neoplasm
poor px
Medullary mass
Medullary mass
Collecting duct carcinoma of bellini

Rare
MEDULLARY
Tubulopapillary histology
High grade cytology (like a met)
PROMINENT DESMOPLASIA
***++34Be12
What should you think about with a renal mass in a child that resembles RCC?
Translocation-associated renal cell carcinoma
Chromosome X
Transcription factor E3 gene (TFE3) (IHC TFE+, EMA weak)
Ca++
Renal pelvic mass
Renal pelvic mass
Urothelial carcinoma

Large cells with dark nuclei.
Dense smooth cytoplasm.
ELONGATED cells
"Cercariform" (tadpole) cells

IHC?
UCC: + 34Be12, CK20, CEA, mucin

RCC: CD10, RCC, PAX2
Most common met to the kidney?
Lung
Adrenal mass
Adrenal mass
Myelolipoma

Fat and hematopoietic elements
Solitary adrenal mass
Solitary adrenal mass
Adrenal cortical adenoma
Common
85% on-functioning (vs carcinomas - most are fxnl)

Numerous NAKED nuclei in a frothy background
Adrenal cortical adenoma
Common
85% on-functioning (vs carcinomas - most are fxnl)

Numerous NAKED nuclei in a frothy background

(<3.5cm "benign cortical nodule")
Adrenal mass
Adrenal mass >5cm
Adrenal cortical carcinoma
Uncommon
Usually fxnl

Isolated cells with INTACT granular cytoplasm (vs adenoma) 
Pleomorphic nuclei
Mitoses

IHC?
Adrenal cortical carcinoma
Uncommon
Usually fxnl
usually >5cm
Isolated cells with INTACT granular cytoplasm (vs adenoma)
Pleomorphic nuclei
Mitoses

IHC?
inhibin+
Calretinin+
MelanA+

(-)EMA, CEA, keratin
inhibin+
Calretinin+
MelanA+

(-)EMA, CEA, keratin
Adrenal mass
Adrenal mass

EM?
Pheochromocytoma
EM shows neurosecretory granules (dark balls)

Adrenal medulla
HTN
20% assoc with familial syndromes (which ones?)

10% bilateral
DO NOT FNA!

cellular, loose clusters and isolated cells. 
Pleomorphic cells, stippled chromatin,
Pheochromocytoma
EM shows neurosecretory granules (dark balls)

Adrenal medulla
HTN
20% assoc with familial syndromes (which ones?)

10% bilateral
DO NOT FNA!

cellular, loose clusters and isolated cells.
Pleomorphic cells, stippled chromatin, INCIs***
MEN2a
MEN2b
Neurofibromatosis
VHL
Most common mets to adrenal?
Lung
RCC
Melanoma
Ovarian cyst
Ovarian cyst
Benign follicular cyst
coarsely granular chromatin
• mix of viable and pyknotic nuclei
• foamy cytoplasm
• mitoses

High estradiol levels (E2)
Benign follicular cyst
coarsely granular chromatin
• mix of viable and pyknotic nuclei
• foamy cytoplasm
• mitoses

High estradiol levels (E2)
Ovarian cyst
Ovarian cyst
Corpus luteal cyst

Isolated luteinized granulosa cells with abundant finely vacuolated cyt
Ovarian cyst
Ovarian cyst
Endometriotic cyst
ovarian cyst
ovarian cyst
detached cilia
exclude follicular cyst

seen in serous cyst, hydrosalpinx, cystic teratoma
Ovarian cyst
Ovarian cyst
Serous cystadenoma

ELEVATED CA125 in cyst fluid
ovarian cyst

Fluid chemistry?
ovarian cyst

Fluid chemistry?
mucinous cystadenoma

HIGH CEA
LOW CA-125, E2
ovarian cyst
ovarian cyst
serous borderline tumor

atypia
Psammoma bodies
Ovarian cyst
Ovarian cyst
Serous cystadenocarcinoma
Marked nuclear atypia
ovarian cyst, large multiloculated
ovarian cyst, large multiloculated
mucinous cystadenocarcinoma
Ovarian cyst
Ovarian cyst
Endometrioid adenocarcinoma
Ovarian cyst
Ovarian cyst
Cystic teratoma
Ovarian mass
Ovarian mass
Granulosa cell tumor
Similar to benign granulosa cells...
Adult type: 95%, postmenopausal. secrete estrogen

highly cellular. Call-Exner bodies. Rd nuc with grooves.

Juvenile type: kids & teens. secrete estrogen. solid. LACKS NUC GROOVES. only 10% aggressive despite high mits. r/o small cell ca of ovary (same age)

IHC?
ALPHA-inhibin
CD99
calretinin
S100
punctate cytokeratin
SMA

(-)CK7, EMA
Most common mets to ovary?
GU
Colon
Stomach (Krukenberg tumor)
Breast
soft tissue
soft tissue
fat necrosis

lacks scalloped nuc of lipoblasts
soft tissue
soft tissue
Floret cell of pleomorphic lipoma
Lipoblast
hyperchromatic, scalloped nuc, large vacuoles
soft tissue
Extremity 70y.o.
soft tissue
Extremity 70y.o.
Myxoid MFH/ myxofibrosarcoma
Curvilinear blood vessels
Marked peomorphism
deep thigh mass
deep thigh mass
low-grade fibromyxoid sarcoma
looks bland but 30% metastasize
myxoid matrix
bland spindle cells

genetics?
low-grade fibromyxoid sarcoma
looks bland but 30% metastasize
myxoid matrix
bland spindle cells

genetics?
t(7;16)
40y.o. thigh mass
40y.o. thigh mass
Myxoid liposarcoma

CHICKEN WIRE VESSELS
SIGNET RING LIPOBLASTS
microcystic change
Sheets of small uniform cells

Genetics?
Unique mets?
Myxoid liposarcoma

CHICKEN WIRE VESSELS
SIGNET RING LIPOBLASTS
microcystic change
Sheets of small uniform cells

Genetics?
Unique mets?
t(12;16)

mets to SOFT TISSUE > spine > lung
Axial skeletal mass
Axial skeletal mass
Chordoma

• granular and fibrillary myxoid matrix
• cohesive clusters and cords of neoplastic cells
• comparatively large cells
PHYSALIPHOROUS CELLS! (bubbly)

IHC?
cytokeratin AND S100 positive
40y.o. thigh mass
40y.o. thigh mass
Extraskeletal myxoid chondrosarcoma

distinctive fibrillar chondromyxoid matrix

IHC?
genetics?
unique mets?
<20% S100
t(9;22)
EWS gene

LATE mets (10y)
Schwannoma
• large, cohesive fragments
• wavy, “fishhook” nuclei
• pointed nuclear ends
• nuclear palisading
• filamentous cytoplasm
S100+
Schwannoma
• large, cohesive fragments
• wavy, “fishhook” nuclei
• pointed nuclear ends
• nuclear palisading
• filamentous cytoplasm
S100+
Teenager thigh mass
Teenager thigh mass
Synovial sarcoma

Characteristic pattern of cohesive cell clusters alternating with dispersed cells

genetics?
Synovial sarcoma

Characteristic pattern of cohesive cell clusters alternating with dispersed cells

genetics?
t(x;18)
Pancreatic cyst, superficial, multilocular
Pancreatic cyst, superficial, multilocular
Lymphoepithelial cyst
Middle age men

Nuc & anucleated squames
lymphs (but squames dominate)
1y.o. with adrenal mass

IHC?
1y.o. with adrenal mass

IHC?
Neuroblastoma

Small primitive cells
Homer-Wright rosettes
Neuropil

IHC: (+)Chromo, synapto, ALK

EM?
Neuroblastoma

Small primitive cells
Homer-Wright rosettes
Neuropil

IHC: (+)Chromo, synapto, ALK

EM?
NEUROSECRETORY GRANULES
NEUROSECRETORY GRANULES
Thigh 19F
IHC?
genetics?
Thigh 19F
IHC?
genetics?
Ewings sarcoma /PNET
CD99+, PAS+
t(11;22)

What else stains with CD99?
small uniform cells with rosettes, pseudorosettes
Cytoplasmic vacuoles
Synovial sarcoma
Embryonal RMS
Characteristics of alveolar rhabdomyosarcoma?
round cell tumor extremities young patients. Highly cellular. Irreg nuclei.
Myogenin+
t(2;13), t(1;13)
Thigh young woman
Thigh young woman
Alveolar soft part sarcoma
Bloody smears
Clusters of cells with round to oval nuclei, prominent large nucleoli, abundant pale finely vacuolated to granular cytoplasm, with fraying of the cytoplasmic margins.

PAS+ 1/cyt magenta pink granules and occasional crystals.
Renal mass child
Wilms tumor
TRIPHASIC (epith, stroma, blastema)
Blastema cells are small round blue cells, can form rosettes