Skip to main content

Posts

Dermatopathology Pearls

Some pointers taken from the Dermatopathology RCPA Quality Assurance Programme: 1. Glomus tumour : It can occur in other places other than the nailbed. Other variants may be glomangioma, glomangiomyoma and symplastic glomus tumour. Malignant glomus tumour is a rare entity. A differential is spiradenoma. 2, Fixed drug eruption : Composed of a combination of erythema multiforme -like changes, mixed inflammatory infiltrate, and melanophages in the superficial dermis. Here is a nice explanation on the clinical features . 3. Chondrodermatitis nodularis helicis Painful nodule typically in the upper part of ear in older males. 4. Naevus cell rests in lymph nodes. Apparently it is not that uncommon (22% of lymphadenectomies in a large study). 5. Superficial acral fibromyxoma Circumscribed but non encapsulated lesions, typically at fingers and toes. Strongly CD34 positive. Differentials include:     1. Low grade fibromyxoid sarcoma: Deep soft tissue lesion, ...
Recent posts

Low grade lymphoma

( This is another final part of the Sabah lymphoma talk: Part One , Two , Three . ) I. Marginal zone B cell lymphoma Types: Nodal, extranodal, splenic. Immunohistochemically different from mantle cell lymphoma, follicular lymphoma, and small lymphocytic lymphoma. Differential diagnosis: Reactive monocytoid B-cell hyperplasia. Patterns: Diffuse pattern: diffuse sheets of neoplastic cells with effacement of nodal architecture. Nodular pattern: distinct nodules, well-demarcated. Interfollicular pattern: neoplastic cells in interfollicular areas that surround residual germinal centres. Perifollicular pattern: annular distribution of neoplastic cells around the uninvolved normal secondary follicles. Histology: Vague nodules with sclerosed blood vessels. Stromal sclerosis which compartmentalize the small groups of neoplastic cells. Monocytoid / plasmacytoid cells, singly distributed or in clusters. Increased large cells with nuclear pleomorphism (not seen in mantle cell l...

Infective Conditions of the Lymph Node (Lymphadenitis)

( This is another continuation of the Sabah Lymphoma talk -- first and second part ) I. Toxoplasma Three features: Follicular hyperplasia. Epithelioid histiocytes. Monocytoid B cells in sinusoids. Enlarged germinal centre (still have mantle zone and tingible body macrophages) II. Viral Partial architectural effacement with expanded paracortex. Polymorphous cellularity. Mottled histological appearance with marked follicular hyperplasia. Infectious mononucleosis Expanded paracortez with heterogenous population. Increased blood vessels. Presence of immunoblasts that mimic Reed-Sternberg cells. Hyperplastic follicles. Herpes simplex virus Mixed cell population. Reed-Sternberg-;ole activated lymphocytes. Apoptotic cells and neutrophils. HIV Early: present with acute reactive lymphadenitis. Late: present with marked CD4+ T-cell depletion, and involution of lymph nodes. 3 phases: Acute Non-specific, more to viral lymphadenitis, eg paracortical exp...

Reactive Conditions of the Lymph Node

(This is a continuation of the notes I have taken from the Sabah Lymphoma talk ) I. Lymphadenopathies Lymphadenopathies are divided into three: 1. Reactive lymphoid hyperplasia 2. Atypical lymphoid hyperplasia 3. Progressive transformation of germinal centre 1. Reactive lymphoid hyperplasia Has a follicular pattern OR may present as diffuse paracortical hyperplasia. Characteristics: architecture preserved, capsule intact, enlarged germinal centre, mitotically active, tingible body macrophages, mantle zone present . Main differential of follicular pattern: follicular lymphoma. 2.  Progressive transformation of germinal centre Mainly in adolescent males. Numerous follicules in different stages with follicular hyperplasia. Late stage: small lymphocytes infiltrating germinal centres, germinal centre disrupted. II. Castleman's disease 1.  Hyaline vascular variant Can be unilocular or multiple places. Numerous follicles with small germinal centre, on...

Autopsy exam

Autopsy exam is a necessity for a trainee anatomic pathologist to pass the final exam, but it is quite a pain to study for it.  I found some brief notes (and possible exam questions) to survive the exam. Assessment: History Gross findings Dissect all organs Make sure dissection area is clean. Cause of death and correlation. How does one diagnose pneumothorax on autopsy? Dissect out the circle of Willis. How to measure ventricular thickness. Answer: 1 cm below the atrioventricular valve How to differentiate between kidney abscess and pyonephrosis. Kidney abscess is usually located at the renal cortex. How to take swabs (from any sites) How to take blood samples. Answer: from femoral vein or right atrium. How to take urine sample. Answer: suprapubic Spleen may also show hyaline arteriosclerosis, like kidneys (hypertensive change). Renal papillary necrosis is common in diabetes mellitus. ARDS (adult respiratory distress syndrome) is a manifestation of ...