APCON 2008 Chennai
NATIONAL
PATHOLOGY QUIZ – 3
Answers
Q 1: Systemic Mastocytosis
The liver biopsy section shows greatly widened portal tracts which are somewhat fibrotic and infiltrated by some dark oval and spindle cells. Can you strain your eyes a little bit and imagine a few dark blue granules in these cells?
If not it doesn’t matter. The trephine biopsy that follows shows the cells in nice detail. Oval and spindle cells with abundant light pink cytoplasm and yet others with darker pink cytoplasm, with few eosinophils lying in between. Granules are not seen in this decalcified section. Here is the Toluidine blue stain of the liver biopsy.
This 38 year old male had cutaneous lesions of Mastocytosis as well.
Correct answers: 20.4%
Links
2. How we diagnose and
treat WHO-defined systemic mastocytosis in adults
Q 2: Sudden
onset severe testicular pain & poorly localized abdominal pain
The slide shows infarction of the testis. The tubules are large and widely spread out because of interstitial edema. The tissue shows obvious coagulation necrosis. Dilated venous channels can also be seen. The most common cause for this is torsion of the spermatic cord.
The Histopathology varies according to the rapidity, duration and extent of torsion.
Many of you have diagnosed this as cryptorchid or atrophic testis. The tubules in that case would be pale, small and fibrotic.
Correct answers: 25.9%
Links
2. Histopathology & Durations of Spermatic Cord Torsion
Q 3: Adenomatoid tumor of Epidydymis. Inappropriate surgery.
The Cytology smear on 12.06.08 shows cohesive clusters of benign looking cells with moderate to abundant eosinophilic cytoplasm. In a small nodule located in the upper pole of the testis, Adenomatoid tumor would be a fair guess. Leydig cell tumors have lot more of scattered cells and less of clustering.
The gross specimen 10.07.08 shows a tumor on the upper pole of the testis – location of epidydymis. Quite a few of you have diagnosed this to be a bone or joint tumor. I guess the specimen has a resemblance to section of the head of femur. But then you can clearly see the spermatic cord in the background.
You were asked to give your critical comment. The main point is that an orchidectomy was done for what is obviously a benign tumor. Many have made a diagnosis of adenomatoid tumor. But sorry, this will fetch only half the credit!
Correct answers: 22.2%
Links
1. Cytologic Features of Paratesticular Adenomatoid Tumor
Q 4:
Small cell carcinoma
Small dark round tumor cells rather strikingly arranged in linear rows or in a ‘string of beads’ pattern. The individual cells have a salt and pepper chromatin and show nuclear molding.
Lobular carcinoma of breast could be a differential, but they are apt to show vacuolated cells and mucin.
Correct answers: 40.7%
Links
1. Small cell carcinoma in fluids (pages from Koss’ Diagnostic cytology)
Q 5: Hyalinizing
Trabecular Tumor
This was kept for pattern recognition – alas, with disappointing results. Many have indeed diagnosed it as paraganglioma or pheochromocytoma which is the basic pattern. (Remember, HTT used to be called Paraganglioma-like adenoma of the thyroid). But then, you also see distinctive nuclear features of clearing and grooving. And there is the hyaline material between cell groups.
Needless to say, this was a small encapsulated nodule within the thyroid; features that were not shown to you.
Many have diagnosed this to be follicular variant of papillary carcinoma, no doubt going by the nuclear features. But the basic pattern of that lesion is typical papillary carcinoma nuclei lining follicles filled with colloid.
There may be some who argue that this is just a solid portion of a papillary carcinoma. But, as they say, Quizmaster’s word is final!
Correct answers: 3.7%
Links:
1. Hyalinizing
Trabecular Tumor
Q 6: Epidermolysis
bullosa (Junctional type)
PAS stained skin section with a sub-epidermal cleavage. The basement membrane is seen to be at the base of the cleft.
Junctional Epidermolysis Bullosa is a generic histological diagnosis which includes different genetic conditions diagnosed more specifically by Electron microscopy and molecular studies.
Porphyria cutanea tarda has been diagnosed by some. But the dermal and vascular changes and deposits of hyaline material are lacking in this case.
Correct answers: 14.8%