Pancreatic ductal adeno. Flat sheets of cells, three dimensional balls, and microacini
Columnar cells with delicate cytoplasm and polar nuclei (basal nuclei, apical cytoplsam)
Open chromatin with prominent central single nucleolus (versus squamous cell carcinoma with nuclei with dense chromatin and several small nucleoli, and dense cytoplasm)
Signet ring cells or intercellular glandular lumens
Hepatoblastoma. Three cell types. undifferentiated (small cells reminiscent of neuroblastoma or Wilms tumor), embryonal cells (slightly more mature cells with large nuclei, scant cytoplasm, arranged in some architectural pattern), and fetal cells (larger cells with abundant cytoplasm, smaller than mature hepatocytes).
Mesothelioma = large complex cell clusters with KNOBBY border. Cell in cell arrangements. Single cells with dense perinuclear cytoplasm and lacy cytoplasm. POS for calretinin, EMA, Alcian blue, CK 5/6, CAM 5.2 and only PAS (glycogen). Neg for PAS-D (glycogen is dissolved), BerEp4, B72.3, CD15, mucicarmine. Have long branching slender microvilli on EM. Can have collagen balls and lymphs.
Scrotum. Granular cell tumor. S100 positive, CD68 positive, inhibin positive. Lysosomes on EM. uvenile xanthogranuloma features histiocytic cells which merge with those with features of Touton-like giant cells. This lesion labels for CD68, but not for S100 or CD1a. Langerhans histiocytosis is composed of cells with more reniform nuclei, and the lesional cells label for CD1a.
DARIER's Disease = This solitary keratotic papule has a somewhat endophytic growth pattern, with a central plug of keratin. There is both acantholysis and dyskeratosis. There is suprabasal acantholysis over a papillomatous superficial dermis. Above the suprabasal acantholysis, there are large, eosinophilic, rounded suprabasal cells with perinuclear halos (Corps Ronds). Above these are small dark cells with pyknotic nuclei and a millet-seed-like
Ewing/PNET. Calf of 11 year old boy. Some of these cells form rosette-like structures. At high power, the lesion comprises of fairly monotonous, small round blue cells with scant cytoplasm, high N:C ratio, and multiple cytoplasmic vacuoles. The Papanicolaou-stained material demonstrates round to oval nuclei with multiple small nucleoli and occasional mitotic figures. Immunohistochemistry shows that the cells are immunoreactive for CD99
Hairy cell leukemia. Never in nodes. BLOOD: mimics aplastic anemia (has characteristic MONOCYTOPENIA and neutropenia- reason you would die from it). Very few neoplastic cells in blood. DO NOT DIAGNOSE if there are monocytes. Classic cell morphology = bigger, with nucleus 2x size of normal one and the cell size is very uniform, no transformed cells. Nuclei can be round, oval, RENIFORM, or bilobed. Chromatin is very distinct ground glass and NO
Marginal zone lymphomas. 1. Nodal = proliferation of monocyoid B cells in a diffuse, sinusoidal or interfollicular pattern, permeates the follicles. Look for Dutcher bodies (ND- nuclear). 2. MALT = small round lymphs with lots of pale cytoplasm and indented nuclei (monocytoid B cells), plasma cells (ND), and lymphoepithelial lesions. The plasma cells are actually monoclonal! Also can see regular old reactive follicles, don't be fooled that
Neuroblastoma, thoracic mass, 11 month old girl. This tumor differs from PNET in that neuroblastoma cells are variable in size, there is extensive neuropil, and focal ganglion cell differentiation may be seen in the form of cells with an amphophyllic cytoplasm and prominent nucleoli. The cells in PNET would be CD99 positive where as neuroblastoma cells would not. “neuroblastoma, stroma poor, poorly differentiated and low MKI
Adenocarcinoma. The cell in focus is comprised of a large nucleus, promininent nucleoli with an eccentric cytoplasm, suggesting glandular differentiation. Another fragment is shown with cells in a cohesive group with subtle cell borders. The nuclear outlines are irregular, and each contains a prominent nucleoli. The degree of atypia is consistent with an adenocarcinoma. The clean smear background is suggestive of a metastasis.
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Lymphoepithelial cyst in thyroid. istologically, they are essentially identifical to branchial cleft cysts located laterally in the neck. The lining epithelium may show any combination of squamous cells, cuboidal cells and even columnar cells with cilia. The most important entity to rule out of the differential diagnosis is a cystic papillary carcinoma where the tumor cells have undergone extensive squamous metaplasia.
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Epithelioid sarcoma. The tumor lesion on low power has the morphology of a palisaded necrotizing granuloma. There appears to be central collagenous necrobiosis, and the lesional cells simulate histiocytes surrounding this necrobiosis. However, the surrounding cells demonstrate fairly prominent nucleoli, and mitotic figures are evident. These cells label for both cytokeratin (shown below) and CD34, establishing the diagnosis of epithelioid sarcoma.
Squamous cell CA in pap smear. large cells with high N:C ratios and macronucleoli.
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Lung cells. Immunofluorescence light micrograph of pulmonary endothelial cells. Endothelial cells are specialized epithelial cells that line the inner surface of blood vessels. Nuclei, which contain the cell's genetic information, are purple; actin filaments, which are major components of the cytoskeleton, are cyan; mitochondria, which generate energy for the cell, are white. © Dr. Torsten Wittmann / Science Source #lungcells #pulmonary #micrograph #sciencephotos #stockimages #sciencesource
canalicular adenoma on lip. it is characterized by double columns of cells forming interconnecting channels that course through a loose myxoid stroma. The cells forming the channels have columnar, uniformly aligned nuclei without atypia or mitotic activity. it has a striking predilection for the upper lip. Although a rare salivary gland tumor overall, they are outnumbered only by pleomorphic adenomas at this specific site.
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