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Smears of needle biopsy with Papanicolaou's stain (or Pap stain). Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA. Microscopic photo 100X with oil.
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Microscopic photo showing tumor cells from a fine needle aspiration cytology smear. Tumor cells exhibit nuclear features of papillary thyroid carcinoma, including indentation of nuclear envelope, deep nuclear groove, ground-glass (optically cleared or “Orphan Annie eye”) appearance of chromatin, and intranuclear cytoplasmic pseudoinclusions. Papanicolaou's stain. 100X Oil. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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A bronchovascular bundle with a bronchiole to the left and an adjacent muscular pulmnary artery to the right. Note the internal and external elastic laminae in the pulmonary artery; this is unique to muscular pulmonary arteries. The external elastic lamina is not present in muscular arteries in the systemic circulation. The bronchiole contains a single elastic lamina and might be mistaken for a blood vessel if the epithelium is missing.
Microscopic photo showing foci of subpleural bullous emphysema (blue arrows). Focal pleural thickening (orange arrow) is identified, with granulation tissue proliferation, acute hemorrhage and scattered eosinophils. Findings are consistent with post pneumothorax reactive changes. H & E stain. 2x. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA.
Ferruginous bodies usually form around asbestos fibers but a variety of other fibers may incite the formation of similar structures. Ferruginous bodies, when seen in the lungs, are almost always indicative of asbestos exposure. The identify of the inciting fibers in this case is not known. The black core indicates that this material may be something other than asbestos since asbestos fibers are usually colorless. Precise identification would require energy dispersive X-ray analysis (EDX - A), electron microscopy, or other techniques.
Image contributed by Dr. Sumeyra Kartal - @sumeyra_md
Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
These needle core biopsy fragments exhibit pale and dark staining areas. See following images for further details.
Asymptomatic 87 year old male with a lesion detected in the right lower lobe. Core biopsy performed. Negative immunostains: AE1/AE3, CAM 5.2, SMA, Actin, Desmin, CD34, CD117, BCL-2, S100, CD56, Chromogranin A, HMB45, CD68. Positive immunostains: FLI-1, CD99 (focally +), Ki-67 (focally + <5%).Molecular studies for synovial sarcoma and Ewing's sarcoma were negative. No significant past medical history and no evidence of extrapulmonary involvement. This sarcoma could not be subtyped. Primary pulmonary sarcomas are very rare accounting for approximately 0.2% of primary pulmonary malignant neoplasms. Metastatic sarcomas are seen far more frequently.
Microscopic view of Meloidogyne enterolobii, commonly known as the guava root-knot nematode at the U.S. Vegetable Laboratory in Charleston, South Carolina, on February 3, 2021.
This is Meloidogyne enterolobii during their infective juvenile life stage (a.k.a. 'J2'). The J2s of this species range in length between 380 to 473 microns and max out at 11-18 microns wide. In comparison, a human hair is approximately 70 microns wide. The ovals around the juveniles are unhatched eggs in various stages of development. The jagged amorphous pieces are plant debris. USDA Photo by William Rutter, Ph.D.
Related information includes:
Controlling Guava Root-Knot Nematode video
tellus.ars.usda.gov/stories/articles/controlling-guava-root-knot-nematode/
Meloidogyne enterolobii Found Infecting Root-Knot Nematode Resistant Sweetpotato in South Carolina, United States at apsjournals.apsnet.org/doi/10.1094/PDIS-08-18-1388-PDN
A Multi-state Effort to Contain and Manage the Invasive Guava Root Knot Nematode (GRKN) in Vegetable Crops.
ars.usda.gov/research/project/?accnNo=437518
Asymptomatic 87 year old male with a lesion detected in the right lower lobe. Core biopsy performed. Negative immunostains: AE1/AE3, CAM 5.2, SMA, Actin, Desmin, CD34, CD117, BCL-2, S100, CD56, Chromogranin A, HMB45, CD68. Positive immunostains: FLI-1, CD99 (focally +), Ki-67 (focally + <5%).Molecular studies for synovial sarcoma and Ewing's sarcoma were negative. No significant past medical history and no evidence of extrapulmonary involvement. This sarcoma could not be subtyped. Primary pulmonary sarcomas are very rare accounting for approximately 0.2% of primary pulmonary malignant neoplasms. Metastatic sarcomas are seen far more frequently.
This end stage of many diverse chronic fibrosing interstitial inflammatory lesions is characterized by spaces lined with respiratory epithelium separated by broad bands of inflamed scar tissue. Hyperplasia of smooth muscle is often prominent. The spaces are predominantly terminal airways; some may be dilated alveoli lined by metaplastic epithelium.The spaces often contain inflammatory cells and mucoid material. At this stage the nature of the lesion that progressed to honeycombing is usually not apparent.
Obstruction of the lumen of the bronchiole by mucoid exudate, goblet cell metaplasia, epithelial basement membrane thickening and severe inflammation of bronchiole.
Pleural surface of left lung covered by purulent exudate. Underlying pneumonia.
Image contributed by Dr. Yale Rosen - @yro854
This end stage of many diverse chronic fibrosing interstitial inflammatory lesions is characterized by spaces lined with respiratory epithelium separated by broad bands of inflamed scar tissue. Hyperplasia of smooth muscle is often prominent. The spaces are predominantly terminal airways; some may be dilated alveoli lined by metaplastic epithelium.The spaces often contain inflammatory cells and mucoid material. At this stage the nature of the lesion that progressed to honeycombing is usually not apparent.
This is a very instructive case of the small cell variant of squamous cell carcinoma (SCC) mimicking small cell lung carcinoma (SCLC) based not only on morphologic features but also on the results of immunostains. CD56 and CK5/6, the immunostains that were initially obtained were both positive. TTF 1, chromogranin A and synaptophysin were negative. A small percentage of squamous cell carcinomas may express CD56 and a small percentage of high grade neuroendocrine carcinomas may express CK5/6. p63 and p40 stains were subsequently obtained and both were positive confirming the diagnosis of SCC. AE1/AE3 was also positive but did not exhibit the dot like staining of the nuclear membranes that is often seen in SCLC. Careful examination of cell morphology at higher magnifications shows some cells with eosinophilic cytoplasm. Nuclear detail is lacking in these images.
Case contributed by Dr. Jian-Hua Qiao.
Asymptomatic 87 year old male with a lesion detected in the right lower lobe. Core biopsy performed. Negative immunostains: AE1/AE3, CAM 5.2, SMA, Actin, Desmin, CD34, CD117, BCL-2, S100, CD56, Chromogranin A, HMB45, CD68. Positive immunostains: FLI-1, CD99 (focally +), Ki-67 (focally + <5%).Molecular studies for synovial sarcoma and Ewing's sarcoma were negative. No significant past medical history and no evidence of extrapulmonary involvement. This sarcoma could not be subtyped. Primary pulmonary sarcomas are very rare accounting for approximately 0.2% of primary pulmonary malignant neoplasms. Metastatic sarcomas are seen far more frequently.
The alveolar walls are thickened by inflammatory cells (predominantly lymphocytes), edema and some fibroblastic proliferation. There is regenerative hyperplasia of Type 2 pneumocytes. Foamy alveolar casts are present.
Microscopic Photo. Chronic hepatitis C. Trichrome stain demonstrates bridging fibrosis with architectural distortion and cirrhosis (stage 4). Trichrome Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
A higher magnification view of one of the pale staining areas shows round and spindle cells intermixed with very few lymphocytes.
Microscopic photo showing numerous calcified psammoma bodies and sheets of spindle-shaped meningothelial cells. H&E stain. Original objective magnification 20X. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Cenizas del Paraná is a tactical and speculative research into the Paraná wetlands in Argentina. Exploring environmental humanities, data science, photogrammetry techniques and aerial and microscopic images, this project looks forward to identifying soils and native plant species that have been damaged and endangered by local wildfires and global climate change. This project takes the form of a transmedia mechano-acoustic installation that embraces the resilient forces of endangered vegetal and rhizospheric communities.
Photo: Florian Voggeneder
Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
Small lymphocytes predominating interspersed with a small number of larger epithelial cells.
Malakoplakia, a condition often associated with immunodeficiency and characterized by abnormal macrophage function consists of sheets of large histiocytes in response to a bacterial infection. It represents a relatively ineffective inflammatory response because of persistence of bacteria and/or bacterial degradation products within the histiocytes. In the lungs it is almost always caused by infection with Rhodococcus equi but it may be caused by other bacteria. Malakoplakia is morphologically very similar to Mycobacterium avium complex infection in AIDS patients and to Whipples disease and lepromatous leprosy. The distinguishing and diagnostic feature of malakoplakia is the presence of small intracellular concentrically calcified structures called Michaelis-Gutman bodies (MG bodies). MG bodies also contain stainable iron. Intracytoplasmic calcifications not having the typical appearance of MG bodies may also be present.
The arrowheads point to intracytoplasmic calcifications that are not diagnostic of MG bodies but are probably related to them.
Microscopic photo showing transmural acute inflammation of gallbladder wall with greater than 90% of eosinophils. H & E stain. 10X Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA.
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Microscopic photo showing tumor cells are diffusely positive for CD-117 with cytoplasmic and membranous staining patterns. IHC stain. Original objective magnification 20x. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA.
Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
A higher magnification view of one of the pale staining areas shows bland appearing, round and spindle cells intermixed with lymphocytes.
Smears of needle biopsy with Papanicolaou's stain (or Pap stain). Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA. Microscopic photo 100X with oil.
The alveolar walls are thickened by inflammatory cells (predominantly lymphocytes), edema and some fibroblastic proliferation. Many foamy alveolar casts are present.
Microscopic photo. The tumor shows stromal hypercellularity, particularly next to epithelial elements. H&E Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
A higher magnification view of one of the dark staining areas showing lymphocytes and large and small islands of the pale staining cells.
This represents a late effect of organization of a thrombus/thromboembolus which is no longer present.
61 year old male who worked in the shipbuilding industry for many decades.
This image shows a asbestos bodies engulfed by 2 giant cells within an alveolus..
Contributed by Dr. Mark Wick.
Extramediastinal (ectopic) thymomas are rare and may occur in the neck, trachea, thyroid, lung and pleura. This case is an example of a pleural based thymoma.
Lymphocytes and an island of pale staining, bland appearing epithelial cells.
Malakoplakia, a condition often associated with immunodeficiency and characterized by abnormal macrophage function consists of sheets of large histiocytes in response to a bacterial infection. It represents a relatively ineffective inflammatory response because of persistence of bacteria and/or bacterial degradation products within the histiocytes. In the lungs it is almost always caused by infection with Rhodococcus equi but it may be caused by other bacteria. Malakoplakia is morphologically very similar to Mycobacterium avium complex infection in AIDS patients and to Whipples disease and lepromatous leprosy. The distinguishing and diagnostic feature of malakoplakia is the presence of small intracellular concentrically calcified structures called Michaelis-Gutman bodies (MG bodies). MG bodies also contain stainable iron. Intracytoplasmic calcifications not having the typical appearance of MG bodies may also be present.
In this image the lung tissue is occupied by a mixed inflammatory cellular infiltrate with a predominance of large histiocytes.
Microscopic Photo. A tubular adenoma with proliferation of neoplastic tubules. The neoplastic glands are lined by hyperchromatic glandular epithelium with elongated nuclei and reduced cytoplasmic mucin production. Surface villous architecture formation is noted. H&E Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Part of a pulmonary blood vessel exhibiting occlusion and recanalization. The nuclei in the fibrous bands that are bridging the lumendo not appear to be those of malignant cells.
Microscopic photo showing tumor cells from a fine needle aspiration cytology smear. Tumor cells exhibit nuclear features of papillary thyroid carcinoma, including indentation of nuclear envelope, deep nuclear groove, ground-glass (optically cleared or “Orphan Annie eye”) appearance of chromatin, and intranuclear cytoplasmic pseudoinclusions. Papanicolaou's stain. 100X Oil. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA.
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Microscopic Photo. Five enlarged renal tubular epithelial cells with enlarged basophilic nuclei with inclusions. Tubular injury is present. H&E Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Sclerosis and narrowing of blood vessel lumens; interstitial fibrosis and mild inflammation; hemosiderin deposition in air spaces and alveolar walls; a few atypical type 2 pneumocytes.
Malakoplakia, a condition often associated with immunodeficiency and characterized by abnormal macrophage function consists of sheets of large histiocytes in response to a bacterial infection. It represents a relatively ineffective inflammatory response because of persistence of bacteria and/or bacterial degradation products within the histiocytes. In the lungs it is almost always caused by infection with Rhodococcus equi but it may be caused by other bacteria. Malakoplakia is morphologically very similar to Mycobacterium avium complex infection in AIDS patients and to Whipples disease and lepromatous leprosy. The distinguishing and diagnostic feature of malakoplakia is the presence of small intracellular concentrically calcified structures called Michaelis-Gutman bodies (MG bodies). MG bodies also contain stainable iron. Intracytoplasmic calcifications not having the typical appearance of MG bodies may also be present.
In this low magnification photomicrograph the lung tissue to the right is occupied by a mixed inflammatory cellualr infiltrte with a predominance of large histiocytes. Relatively uninvolved lung tissue is seen at the left.
Microscopic Photo. The neoplastic glands are lined by hyperchromatic glandular epithelium with elongated nuclei and reduced cytoplasmic mucin production. The normal crypts are at right lower corner. H&E Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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Microscopic image of a pulmonary corpus amylaceum with central black-brown inclusion. Corpora amylacea are large, round to oval glycoprotein structures that are found within alveoli in a variety of circumstances. They have been reported to be present in up to about 4% of autopsy lungs and are incidental findings with no known clinical significance. They should be distinguished from alveolar microlithiasis. They often contain central inclusions which may appear as black fragments, crystals or ring forms. Prominent central black inclusions said to be birefringent are seen in these structures.
Image contributed by Dr Sanjay Mukhopadhyay - @smlungpathguy
In this case only a very small amount of tumor tissue is present. Without the aid of immunohistochemistry the diagnosis would be "non-small carcinoma, NOS". This diagnosis would not be helpful in the selection of targeted therapy. The immunostains (see following) clearly indicate that this is a squamous cell carcinoma.
Microscopic Photo. Gastric antral mass biopsy showing neoplastic intestinal glands resembling colonic adenocarcinoma, consistent with intestinal type gastric adenocarcinoma. H&E Stain. Jian-Hua Qiao, MD, FCAP, Los Angeles, CA, USA
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