--- # System prepended metadata title: Patho Micro IIIb --- # Patho Micro IIIb ## Nervous System (1) * 一. PA0159 ( 136 ) Oligodendroglioma, cerebrum, 46F ( P.7 ) * ![](https://i.imgur.com/2SgfMBD.jpg) * Diffusely infiltrating (看不出border) * Chicken-wired capillaries * Cytology: * perinuclear halo: fried-egg (artifact) * Mini-gemistocyte: 核圓且偏一邊、fine chromatin、質紅 * ![](https://i.imgur.com/VPKAbFe.jpg) * 二. PA0160 ( 137 ) Glioblastoma (multiforme), cerebrum, 56M ( P.20 ) * AM**EN**: **e**ndothelial proliferation (**微血管增生**), **n**ecrosis (**palisading**) → grade IV * ![](https://i.imgur.com/5wfelSR.jpg) * Hypercellular的地方: fibrillary background, satellosis, 核圓、有pleomorphism * 三. PA0163 ( 139 ) Pilocytic astrocytoma, cerebellum, 24F ( P.32 ) * **Biphasic growth** * ![](https://i.imgur.com/llFkLY0.jpg) * Fibrillay area, Hypercellularity * **Piloid cells (bipolar, hair-like process細長)** * Rothenthal fibers (不specific) * Microcystic area, Hypocellularity * Eosinophilic granular bodies (EGB) * myxoid stroma很多飄在上面的tumor cell, 長得像oligodendroglioma的perinuclear halo ## Nervous System(2) * 一. PA0165 (141) Meningioma, meninx, 81F (P.3) * from dura * **Storiform pattern (梵谷星夜@MPF)**: spindle tumor cell * ![](https://i.imgur.com/i9AwClQ.jpg) * Whorling pattern @HPF * ![](https://i.imgur.com/QBJm132.jpg) * psammoma body * **Focal syncytial lobules: meningothelial** * ![](https://i.imgur.com/DSziCo0.jpg) * 二. PA0227 (168) Medulloblastoma, desmoplastic/nodular, cerebellum (roof of fourth ventricle), 10M (P.21) * Densely cellular一整片 * ![](https://i.imgur.com/NuuntY0.jpg) * **Desmoplastic/Nodular** (nodule [neuropil-like matrix, 粉紅] 外hyperchromatic tumor & reticular fiber fibrosis) * ![](https://i.imgur.com/mRqyWaz.jpg) * neuronal differentiation → 可能有Homer-Wright rosette * Cytology: 小藍圓、N/C高 (@nodule); pleomorphic, 細胞較黑 (@nodule外) * 三. PA0230 (169) Choroid plexus papilloma, fourth ventricle, 51F (P.33) * 單層上皮包圍fibrovascular core, columnar * ![](https://i.imgur.com/4tcKCIN.jpg) ## Nervous System (3) * 一. PA0232 ( 171 ) Ependymoma, spinal cord, 46F (P.4) * ![](https://i.imgur.com/QIjStWt.jpg) * **Perivascular pseudorosette**: 內到外為血管、ependymal process、ependymal cells * ![](https://i.imgur.com/qeWvXy4.jpg) * 圓核、granular chromatin * 二. PA0231 ( 170 ) Germinoma, sellar region, 25F (P.16) * ![](https://i.imgur.com/GWP3gTO.jpg) * **Large polygonal tumor cells** (**pale staining**, vacuolated, 核大、明顯不規則核仁) 周圍有thin fibrous septa圍成不完整的lobule * **Lymphocytic infiltrate (hyperchromatic)** * ![](https://i.imgur.com/hrA4gpf.jpg) * 三. PA0245 ( 185 ) Arteriovenous malformation, cerebrum, left frontal lobe, 17M (P.28) * ![](https://i.imgur.com/APT5pS9.jpg) * **Hyalinization or fibrosis** (管壁) * 不正常的靜脈/動脈間有**CNS gliotic tissue** * ![](https://i.imgur.com/GwrHpqB.jpg) * Internal elastic lamina * ![](https://i.imgur.com/Yh4EtBT.jpg) ## Skin * 一. PA0193 (121) Seborrheic keratosis, skin (trunk), 55F (P.5) * 脂漏性角化症 * ![](https://i.imgur.com/kCMq9Qm.jpg) * **Horn cyst** (塞keratin的cyst) & invagination cyst (表面折進去) * ![](https://i.imgur.com/5xNxnsp.jpg) * ![](https://i.imgur.com/GkHEPul.jpg) * Cytology: basaloid (N/C高、較藍) sheets * 二. PA0137 (113) Verruca vulgaris, skin (finger), 28M (P.22) * 常見疣 * **Undulent** **papillomatous/verrucous** hyperplasia * keratohyaline granule: 高高低低像峰林，山之間（或山谷）有黑色一點點像小鳥，大又粗 * ![](https://i.imgur.com/4ycfECC.jpg) * ![](https://i.imgur.com/NcxsXCb.jpg) * parakeratosis: 山峰向上延伸、死掉keratocyte的細胞核一小點一小點 * koilocytic atypia: 核大 (顏色淡淡的)、核膜不規則、核周空 * ![](https://i.imgur.com/dfVU914.jpg) * 三. PA0139 (115) Bullous pemphigoid, skin (ankle), 91F (P.45) * ![](https://i.imgur.com/QohjUJm.jpg) * Subepithelial blister: 表皮跟真皮分離，真皮可能再次新生(re-epithelialization) * non-acantholytic: * Eosinophils * 四. PA0140 (116) Psoriasis, skin, 36M (P.57) * ![](https://i.imgur.com/Jj1vFEn.png) * **Psoriasiform hyperplasia**: rete ridges往下長，延伸的level都差不多 * parakeratosis * hypogranulosis: stratum granulosum變薄 * suprapapillary plate薄 * Munro's microabscess: neutrophil在stratum corneum * 五. PA0254 (188) Lichen planus, skin (P.73) * **Lichenoid dermatitis:** * **Band-like**淋巴球浸潤 * 表皮basal cell破壞: Civatte bodies: apoptotic紅無細胞核 * vacuolar degeneration * ![](https://i.imgur.com/AsYmN6M.jpg) * hyperkeratosis * Sawtooth appearance: rete ridges往下長破碎細尖 * hypergranulosis: wedge-shaped顆粒層增生 * ![](https://i.imgur.com/DmE4PxG.jpg) ## Bones * 一. PA0145 (122) P.4 Osteopetrosis, bone (femur), 47M * ![](https://i.imgur.com/q9sM8CL.jpg) * Primary spongiosa: osteoclast無法remodeling * **Endochondral ossification沒方向性**: 到處都有軟骨骨化(紅色)穿插在cartilage matrix(白色) * 二. PA0148 (124) P.13 Osteochondroma, bone (femur), 10M * **Cartilaginous cap (endochondral ossification) + osseous stalk** * ![](https://i.imgur.com/ZwewmUz.jpg) * 三. PA0147 (174) P.24 Chondrosarcoma, bone (phalanx), 34M * ![](https://i.imgur.com/5q80KPY.jpg) * **Lobulated** tumor * **Myxoid/Chondroid matrix** * Ossification: reactive bone formation * **Malignant feature**: * **核大黑多**、核深色、核多型(尖尖)、核異變(atypia, 大)、核仁明顯 (*enchondroma沒有*) * infiltrative: 吃出cortex * 五. PA0146 (123) P.56 Osteosarcoma, bone (humerus), 14M * ![](https://i.imgur.com/r0QhqVu.jpg) * **Lace-like Osteoid matrix**: 方向差不多 (c.f. Fibrous dysplasia) * Dysplasia: * 核大黑 * tumor giant cell (多核) * ![](https://i.imgur.com/D86zFrd.jpg) |Osteochondroma|Chondrosarcoma|Osteosarcoma| |---|----|----| |Cellularity高、Nuclear polymorphism|核大黑、病變生成cartilage|Malignant (lace-like osteoid)| * 六. PA0149 (125) P.66 Giant cell tumor of bone, bone (tibia), 43F * ![](https://i.imgur.com/fEVfsV4.jpg) * borderline, 有**giant cell: 有些核淡淡(和一般osteoclast及stromal cell [mononuclear] 型態差不多**)有些核黑 * ![](https://i.imgur.com/KnPK9Yg.jpg) * hemosiderin * degeneration: cystic (次級aneurysmal bone cyst), fibrosis, ossification (形成woven bone) * 七. PA0151 (121) P.82 Fibrous dysplasia, bone, 39F * ![](https://i.imgur.com/2hWR8UK.jpg) * Woven bone: **disoriented**: 像中文字 (**Chinese character**) * **Fibrous background**: fibroblastic proliferation * ![](https://i.imgur.com/p5z2aug.jpg) * 八. PA0152 (128) P.95 Tenosynovial giant cell tumor, diffuse type (**PVNS**, pigmented villonodular synovitis), joint (knee), 57F * ![](https://i.imgur.com/x3XPJhA.jpg) * **Villous & nodular** components * **Hemosiderin** * Synoviocyte (**小單核histiocytoid**, villi內部, foamy [核沒有被推到一邊]) * ![](https://i.imgur.com/jWYaZOz.jpg) * 九. PA0153 (129)P.111 Gouty tophus, joint (knee), 69M * **淡粉紅大小不一lobules**，有包圍giant cell [epithelioid histiocytes & multinucleated giant cell]、fibrous septum * 尿酸結晶細長尖 * ![](https://i.imgur.com/nTyQYGX.jpg) ## Diseases of soft tissue * 一. PA0157 ( 133 ) Synovial sarcoma, soft tissue ( foot ) , 37M * Biphasic: Monophasic + epithelial component * ![](https://i.imgur.com/h37b38A.jpg) * **單調spindle cells**: 多、N/C高、核靠在一起、**核卵長狀、short fascicles** * ![](https://i.imgur.com/c0eqSMH.jpg) * Epithelial: 上皮部份顏色**較藍較深、構成洞洞**、網束腺管泡指狀、cuboid/columnar圓胖 (整體而言像adenocarcinoma但是有spindle component) * ![](https://i.imgur.com/xkVT8SE.jpg) * 二. PA0256 ( 189 ) Dedifferentiated liposarcoma, thigh, 58M * **Non-lipogenic** (有有fat之處也有沒fat之處=>dedifferentiated) * ![](https://i.imgur.com/lmfcxIw.jpg) * **Pleomorphism明顯、N/C高** * ![](https://i.imgur.com/6djwNE4.jpg) * ![](https://i.imgur.com/ri0pkZL.jpg) ## 重點 * Osteosarcoma: fiber較紅 * Osteochondroma: fibrous cap * synovial sarcoma vs. meningioma * dedifferentiated liposarcoma: 一邊有fat一邊沒有 ||同側|雙|ENE(+)| |---|---|---|---| |<3|N1|N2a, 一顆|N2a, 一顆| |3~6|N2a, 一顆;
N2b, 多顆|N2c, 多顆|N3b| |>6|N3a|N3a|N3b|