thyroid: adenoma lab 7, case 1. thyroid nodule note that the mass is well circumscribed and there is...

Thyroid: Adenoma

Lab 7, Case 1

Thyroid Nodule

Note that the mass is well circumscribed and there is a sharp line of demarcation between the mass and the adjacent thyroid tissue (arrows).

High-power view of the border between the tumor mass and adjacent thyroid tissue

Note that the mass has compressed the adjacent normal thyroid tissue (arrow). Also note the different morphology between the adenoma (very cellular, dense follicles, little or no colloid) and the adjacent normal thyroid (larger follicles, colloid).

Adenoma Thyroid

Note the compression of the adjacent normal thyroid and the difference in morphology between the adenoma and the thryoid.

Densely packed follicular pattern in the adenoma (left) and the larger colloid-filled follicles of the normal thyroid on the right

An area of compressed thyroid is present adjacent to the adenoma (arrow).

Note that the follicular architecture is well developed and more or less uniform throughout this section of the adenoma.

Relatively normal cellular architecture of this follicular adenoma

Breast: Fibroadenoma

Lab 7, Case 2

Three ovoid, well-circumscribed nodules surrounded by fibroadipose tissue

Higher magnification of one of the three nodules

At this power, the nodule seems to be composed of a solid parenchyma with small glandular spaces. The adjacent breast parenchyma consists mostly of fat.

Fibroadenoma

Dense stroma of the tumor surrounding the irregularly shaped ducts

The adjacent fibrofatty tissue containing breast ducts and lobules has been compressed by the tumor.

Compressed connective tissue (arrow) between two nodules of dense fibrous tissue and ducts

FibroadenomaDucts embedded in connective tissue

FibroadenomaDense stroma of the tumor surrounding the irregularly shaped ductThe ducts are lined by two cell layers, one of cuboidal, two columnar cells (inner layer), and an outer layer of flattened cells with hyperchromatic nuclei (myoepithelial cells)

FibroadenomaIrregularly shaped ducts lined by two cell layers of cells, as previously described

Lips: Squamous Cell Carcinoma

Lab 7, Case 3

Pre-op photo of patient with an ulcerated lesion on his lip (arrow)

The area for surgical excision is outlined in black. Also note that the lip is somewhat thickened.

Squamous Cell Carcinoma of the Lip

1: Focal Ulceration

2: Tumor infiltration at the vermilion border

Large area of ulceration (arrow) with underlying congestion and hemorrhage

The area of ulceration is adjacent to an area of tumor infiltration.

Well-differentiated Squamous Cell Carcinoma and the inflammatory cell infiltration

Squamous Cell Carcinoma and inflammatory cells

Well-differentiated Squamous Cell CarcinomaNote the intracytoplamic keratinization which gives the cells a glassy appearance. The focal accumulations of keratinized cells are called keratin pearls (arrows).

Poorly differentiated area of tumor

Note the spindle-shaped cells and the irregular pattern of growth.

Section of muscle from the lip biopsy

Note that the squamous cell carcinoma has infiltrated into the muscle tissue. There are also inflammatory cells within this area of tumor infiltration.

Esophagus:Squamous Cell Carcinoma

Lab 7, Case 4

Luminal surface of esophagus

1: Area of constriction (protrudes into lumen)

2: Central area of ulceration

Cross-section through esophagus at area of constriction

Shows extensive infiltration of the esophageal wall with squamous cell carcinoma (arrows)

Normal epithelium undergoing transition to carcinoma (arrows)

Invasive squamous cell carcinoma

Tongues and islands of tumor cells exhibit areas of central necrosis (arrow).

Bands of tumor cells invading into the adjacent tissues (arrows)

Bands of tumor cells (arrows) extending between the muscle bundles

Tumor cells that have invaded the adjacent muscle tissue

Colon: Adenocarcinoma

Lab 7, Case 5

Adenoma from the surgical specimen

Note the large, ulcerated, fungating annular (encircling) carcinoma (1) with areas of hemorrhage (2). Also note the adenomatous polyps (3).

Closer view of previous image demonstrating the raised, annular carcinoma (arrows)

Transition between normal mucosa on the left and carcinoma which is invading the wall of the bowel (arrow)

Transition between the normal (1) and the neoplastic (2) epithelium

Tumor cells invading the underlying muscularis

Tumor cells forming glands

Tumor cells forming glands

Ulcerated adenocarcinoma (arrows) at the rectosigmoid junction

Distal colon

Note the annular tumor that severely compromises the lumen of the colon. There is dilation of the colon proximal to the tumor.

Lung and Liver: Metastatic Adenocarcinoma

Lab 7, Case 6

Multiple, variably-sized pale/white-tan nodules scattered throughout the liver

Multiple, variably-sized pale/white-tan nodules scattered throughout the lung

Section of liver (left) and lung (right) containing tumor nodules (arrows)

Interface between the tumor (top) and normal liver parenchyma (bottom)

Tumor cells (arrows) have infiltrated into the liver parenchyma

Tumor cells forming glands (arrows)

Tumor nodule in the lung

The tumor cells are infiltrating into the lung parenchyma (1). There is a large area of necrosis in the center of the tumor (2).

Edge of the tumor nodule in the lung

The tumor cells are infiltrating into the lung parenchyma (1). Even at this power, you can see the glandular formation of this adenocarcinoma. There is a large area of necrosis in the center of the tumor (2).

Edge of the tumor nodule in the lungThe tumor cells are growing in a glandular pattern. The area of necrosis is evident at the right side of the image.

Breast: Infiltrating Ductal Carcinoma

Lab 7, Case 7

Surgical specimen of breast with infiltrating duct carcinoma

Note the tumor tissue under the area of the nipple. The tumor infiltrates in an irregular fashion into the breast parenchyma. Note the nipple retraction caused by this neoplasm.

Sections of normal breast (lower) and breast tissue with infiltrating duct carcinoma (upper)

Note the increased cellularity (increased blue staining due to the increased number of nuclei) in the tumor tissue.

Section of breast with small groups of carcinoma cells throughout the breast tissue and invading through the dermis

Abundant groups of tumor cells dissecting through the breast parenchyma

Tumor infiltration (infiltrating duct cell carcinoma)

Cellular and nuclear features of the tumor cells

The large epithelial cells form glands and are medium-sized with a moderate amount of cytoplasm, vesicular nuclei, and nucleoli.

Breast tissue with abundant fibrous tissue throughout the tumor (desmoplasia, scirrhous carcinoma)

Periphery of tumor

Bands of tumor cells infiltrating into the fat tissue

Growth pattern of the tumor

The tumor consists of malignant duct-lining cells growing in cords, solid cell nests, tubules, and glands. The cytologic detail of tumor cells varies from small cells with moderately hyperchromatic, regular nuclei to large cells with large, irregular, hyperchromatic nuclei.

Skin: Malignant Melanoma

Lab 7, Case 8

Skin with melanoma

Note the black pigment, multiple satellite nodules, and focal ulceration. Some of the satellite nodules affect the nipple.

Lymph nodes almost entirely replaced with black pigment (melanin)

This lymph node has a capsule (1) and some remaining lymphocytes (2) but the remainder of the node is replaced by tumor cells.

Remaining portion of lymph node (arrow)

The rest of the lymph node is invaded by a neoplasm composed of cells with lighter eosinophilic cytoplasm and pigment

Abundant extracellular melanin (arrows) surrounding the tumor cells

This section of neoplasm shows the numerous cells with abundant cytoplasm and brown pigment within the cytoplasm of some of these cells.

Abundant extracellular melanin (brown pigment) surrounding the tumor cells

Main tumor mass with the cells growing as poorly formed nests and sheets of cells

There is little if any pigment in this section.

Main tumor mass

The individual melanoma cells contain large nuclei with irregular contours having chromatin clumped at the periphery of the nuclear membrane and prominent red (eosinophilic) nucleoli.

Lung: Bronchogenic Carcinoma

Lab 7, Case 9

Bronchogenic Carcinoma

The large tumor mass can be seen adjacent to the bronchus (1). Note that the epithelium surface of the bronchus is rough and irregular (2). The first branch off of the right main stem bronchus is partially occluded by the thickened mucosa and submucosa (3).

Normal mucosa (1) with transition to carcinoma (2)

Note the bronchial cartilage (3) and the invasion of tumor through the entire wall of the bronchus with tumor extending to the serosal surface (4).

Bronchus

1: Ulcerated mucosal surface

2: The submucosa is completely filled with tumor down to the cartilage

Bronchus with ulcerated mucosal surface on the right and tumor underneath

Mucosal surface (right) with an area of hemorrhage (arrow) and underlying tumor (left)

Area of invasion with compression of fibrous stroma and focal necrosis

Cytologic detail of tumor

1: Area of necrosis

2: A more differentiated area with keratin pearl formation

Tumor with central area of necrosis (arrow)

Cytologic detail of less-differentiated area of neoplasm with cellular anaplasia

Ileocecal Valve: Carcinoid

Lab 7, Case 10

Surgical specimen

Eosinophilic and basophilic areas delineating areas of tumor infiltration

Arrows: Nests of tumor cells

Tumor growth pattern: Cells form discrete islands, trabeculae, and glands

The tumor cells are monotonously similar with scant, pink, granular cytoplasm and a round-to-oval stippled nucleus. As in most carcinoid tumors, there is minimal variation in cell and nuclear size, and mitoses are infrequent or absent.

Subcutaneous masses in cecum

Note that the mucosa (1) is mostly normal and the tumor cells are in the submucosa (2).

Higher power of previous image

Intact mucosa (right) and the submucosal carcinoid tumor

Subcutaneous mass in cecum

The mucosa is normal and the tumor cells are in the submucosa.

1: Intact mucosa

2: A gland

3: Submucosal carcinoid tumor cells

Cecum containing tumor stained to demonstrate the secretory granules in these tumor cells (brown-colored stain)

The blue color is the mucin in the glands just under the mucosal surface.

Higher power view of previous image

Brown: Carcinoid tumor cells

Blue: Glands

Section from previous images stained with silver to delineate carcinoid tumor cells

Femur: Osteosarcoma

Lab 7, Case 11

Tumor in distal femur

Surgical specimen with tissue dissected away to demonstrate the tumor mass

Cut section of distal femur containing the tumor

The periosteal involvement is evident (arrows).

Decalcified section of this tumor

Note the blue color (cell nuclei stain blue) of much of this section indicating the increased cellularity of the tumor.

Decalcified section of this tumorAreas of osteoid (1) and cellular areas (2)

Decalcified histologic section showing the cellularity of the tumor

Note that the cells are fusiform and they grow in sheets.

Demonstrates growth pattern and cellular morphology

Tumor cell morphology and the periosteum (arrow)

Fusiform morphology of the tumor cells

Note the marked variablilty in size and staining intensity of the nuclei.

Anaplastic cell morphology

Anaplastic cell morphology

Anaplastic cell morphology and multiple mitotic figures (arrows)