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Thursday, September 09 2010 @ 11:15 PM CDT

Pediatric Pathology
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Flexner-Wintersteiner rosettes
Retinoblastoma
Thursday, April 30 2009 @ 01:18 PM CDT
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Biphasic pattern of cytotrophoblast alternating with sheets of syncytiotrophoblast. These cells show nuclear atypia and prominent cytoplasmic vacuoles. Mitotic figures are frequent. Extensive areas of hemorrhage and necrosis are present. The syncytiotrophoblast stain intensely for human chorionic gonadotropin and weakly for human placental lactogen with immunohistochemistry. Cytotrophoblast do not stain with either.
Choriocarcinoma
Thursday, April 23 2009 @ 01:10 PM CDT
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The tumor is composed of sheets of cells consistent with intermediate trophoblast that invade and replace the myometrium. Mitotic figures are frequent. Nuclear atypia is focally seen. No inflammatory infiltrate is present. The trophoblast stain intensely for human placental lactogen and weakly for human chorionic gonadotropin with immunohistochemistry.
Placental Site Trophoblastic Tumor
Thursday, April 23 2009 @ 01:04 PM CDT
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Giant cell transformation is a non-specific reaction by the liver. It can be idiopathic as in this case. It is frequently seen in response to infection such as congenital syphilis, CMV or HIV infections. It may be the only change seen in the biopsy for extrahepatic biliary atresia. Inborn errors of metabolism such as alpha 1-antitrypsin deficiency, galactosemia, hereditary fructose intolerance, tyrosinemia, and neonatal hemochromatosis. All of these must be ruled our prior to designating the disorder as idiopathic. The outcome in non familial neonatal hepatitis is 60% recovery, 10% persistent fibrosis or inflammation, 2% develop cirrhosis and 30% die. Familial cases have a much worse outcome with only 30% recovery, 10% chronic liver disease and cirrhosis and 60% die.
Idiopathic neonatal hepatitis with giant cells
Thursday, April 23 2009 @ 12:54 PM CDT
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Look for MNTI
Melanotic Neuroectodermal Tumor of Infancy
Friday, August 08 2008 @ 07:44 PM CDT
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Melanotic neuroectodermal tumor of infancy (MNTI) is a relatively uncommon osteolytic-pigmented neoplasm that primarily affects the jaws of newborn infants. The lesion has had an interesting history since its initial description by Krompecker in 1918 as a congenital melanocarcinoma.The histologic appearance of MNTI is unique and characteristic in that a distinct biphasic pattern exists. A moderately vascular fibrous background supports the MNTI. The peripheral borders are faintly noted, at best, by a thin, delicate, fibrous layer; however, most often, this nonencapsulated tumor shows local infiltration into the adjacent bone. One portion of the lesion contains large polygonal cells arranged in sheets or alveolarlike structures. These large cells appear, under hematoxylin and eosin staining, to have pale abundant cytoplasm and pale nuclei with finely dispersed chromatin. These cells often contain the melanin pigment that gives the MNTI its blue-black clinical appearance. Fontana stain can be used to enhance the demonstration of the melanin pigment. The cuboidal polygonal cells are at the periphery of the alveolar spaces, while the central portion contains the second smaller characteristic cell type. These cells are lymphocytelike or neuroblastlike with small, dark nuclei and little, if any, cytoplasm. These cells occasionally also form isolated clusters of their own within the fibrous stroma. Throughout the lesion, mitoses are rare but, when present, are normal in appearance. Cellular pleomorphism is scant. The few reported malignant cases of MNTI have little variation from the description above other than an increase in mitoses (3 or more per high-power field), hypercellularity, and focal necrosis. The malignant diagnosis is more one of increased growth rate, infiltration, and metastases. Metastatic lesions have been described in the lymph nodes, the liver, the adrenal gland, the spinal cord, and a variety of other sites. Immunohistochemistry is of assistance in cases that are more difficult to diagnose. The cuboidal cells express cytokeratin as well as melanoma-associated antigen (HMB-45), but they are usually negative for S-100. Some cells are also positive for vimentin, epithelial membrane antigen, glial fibrillary acidic protein, neuron specific enolase (NSE), and synaptophysin.Electron microscopic examination demonstrates ultrastructural evidence of neural, epithelial, and melanocytic features. Fine, delicate cytoplasmic fibers are suggestive of neurofibrils, reminiscent of glial tissue. Typically, some of the cells demonstrate neurosecretory granules. Evidence exists of basal laminae and interdigitating desmosomal attachments to adjacent cells, which is suggestive of epithelial features in some cells. Finally, melanosomes are noted in many of the cuboidal cells. REF: http://www.emedicine.com/derm/TOPIC680.HTM
Melanotic Neuroectodermal Tumor of Infancy
Friday, August 08 2008 @ 08:36 PM CDT
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Ganglioneuromas and ganglioneuroblastomas are tumors of the sympathetic nervous system that originate from neural crest sympathogonia, which are completely undifferentiated cells of the sympathetic nervous system. Along with neuroblastomas, ganglioneuromas and ganglioneuroblastomas are collectively known as neuroblastic or neurogenic tumors.1 Most frequently occurring in the abdomen, these tumors can grow wherever sympathetic nervous tissue is found. Common locations for ganglioneuromas and ganglioneuroblastomas include the adrenal gland, paraspinal retroperitoneum (sympathetic ganglia), posterior mediastinum, head, and neck; it is uncommon to find them in the urinary bladder, bowel wall, abdominal wall, and gallbladder.The primary histologic features of these tumors are neuroblasts (immature, undifferentiated sympathetic cells), ganglion cells (mature cells), Schwann cells, and stroma (tissue surrounding the ganglion cells). Secondary histologic features include necrosis, mitosis, hemorrhage, fibrosis, calcification, lymphocytic infiltrate, and karyorrhexis (fragmentation of cellular nuclei that usually symbolizes cell death). Ganglioneuromas are considered to be mature tumors that do not have immature elements such as neuroblasts and mitotic activity. The presence of neuroblasts automatically makes the tumor a ganglioneuroblastoma or neuroblastoma, thereby excluding the diagnosis of ganglioneuroma. Ganglioneuromas average 8 cm in size and have a pseudocapsule. They are firm to the touch and have a light color, ranging from white to yellow. Internally, the tumor may have a whorled appearance, with trabeculae. Risk groups These neoplasms are histologically classified into risk groups by using 2 distinct systems: the Shimada classification (see the eMedicine article Neuroblastoma in the Pediatrics section for a discussion of the Shimada classification system) and the Pediatric Oncology Group (POG) classification.9 These systems are not meant for staging the disease; instead, they use histologic features to assess the prognosis of a specific tumor. The POG classification system uses only the histologic differentiation of the tumor components to assess the prognosis. Ganglioneuroma, for example, has completely mature and differentiated cells and stroma; therefore, patients with ganglioneuroma have a good prognosis. Ganglioneuroblastoma, on the other hand, is composed of both mature ganglion cells and immature neuroblasts; therefore, it is considered to have an intermediate potential for malignancy. The Shimada classification considers patient age in addition to the histologic appearance in the stratification of a tumor. Histologic features taken into consideration are stromal components (stroma-rich tumors are more mature than stroma-poor tumors), grade, cellular differentiation, and nuclear morphology. Each of these categories is further divided into multiple subcategories. The tumors are eventually classified as having either favorable or unfavorable histologic characteristics. Favorable histologic characteristics are usually found in patients younger than age 1.5 years with a low-to-intermediate mitosis-karyorrhexis index (MKI) and a differentiating or partially differentiating tumor, and in patients aged 1.5–5 years with a low MKI and a differentiating tumor. All remaining combinations are classified as unfavorable histologic characteristics. "The mitosis-karyorrhexis index (MKI) is defined as the number of tumor cells in mitosis and in the process of karyorrhexis. Mitotic figures are characterized by more or less rod-shaped condensations of chromatin, with spiked projections and the absence of a nuclear membrane. Karyorrhectic cells show condensed and fragmented nuclear material usually accompanied by condensed eosinophilic cytoplasm."
Ganglioneuroblastoma
Saturday, August 02 2008 @ 05:56 PM CDT
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Placental villitis at the bottom is seen in conjunction with hydropic change at the top in this placenta with congenital cytomegalovirus (CMV) infection. Both of these microscopic changes can occur together. Congenital infection is a common cause for hydrops fetalis.
Placental CMV Infection
Saturday, August 02 2008 @ 05:56 PM CDT
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Placental villitis at the bottom is seen in conjunction with hydropic change at the top in this placenta with congenital cytomegalovirus (CMV) infection. Both of these microscopic changes can occur together. Congenital infection is a common cause for hydrops fetalis.
Placental CMV
Saturday, August 02 2008 @ 05:56 PM CDT
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Placental villitis with a microabscesses containing mostly neutrophils in a case of congenital infection with Listeria monocytogenes.
Placental Listeriosis
Saturday, August 02 2008 @ 05:56 PM CDT
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Histiocytic (CD68+) infiltrate in intervillous spaces without villitis Associated with perinatal mortality of 80%. Maternal risk factors: diabetes, hypertension, intravenous drug abuse, preeclampsia, systemic lupus erythematosus
Chronic Histiocytic Intervillositis
Saturday, August 02 2008 @ 05:56 PM CDT
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Amnion nodosum is a localized accumulation of amorphous material (vernix caseosa) with embedded desquamated fetal skin cells to produce small nodules. Amnion nodosum is more likely to occur when there is oligohydramnios.
Amnion Nodosum
Saturday, August 02 2008 @ 05:56 PM CDT
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