# Patho Micro IIIb
## Nervous System (1)
* 一. PA0159 ( 136 ) Oligodendroglioma, cerebrum, 46F ( P.7 )
* 
* 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
* 
* 二. PA0160 ( 137 ) Glioblastoma (multiforme), cerebrum, 56M ( P.20 )
* AM**EN**: **e**ndothelial proliferation (**微血管增生**), **n**ecrosis (**palisading**) → grade IV
* 
* Hypercellular的地方: fibrillary background, satellosis, 核圓、有pleomorphism
* 三. PA0163 ( 139 ) Pilocytic astrocytoma, cerebellum, 24F ( P.32 )
* **Biphasic growth**
* 
* 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
* 
* Whorling pattern @HPF
* 
* psammoma body
* **Focal syncytial lobules: meningothelial**
* 
* 二. PA0227 (168) Medulloblastoma, desmoplastic/nodular, cerebellum (roof of fourth ventricle), 10M (P.21)
* Densely cellular一整片
* 
* **Desmoplastic/Nodular** (nodule [neuropil-like matrix, 粉紅] 外hyperchromatic tumor & reticular fiber fibrosis)
* 
* 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
* 
## Nervous System (3)
* 一. PA0232 ( 171 ) Ependymoma, spinal cord, 46F (P.4)
* 
* **Perivascular pseudorosette**: 內到外為血管、ependymal process、ependymal cells
* 
* 圓核、granular chromatin
* 二. PA0231 ( 170 ) Germinoma, sellar region, 25F (P.16)
* 
* **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)**
* 
* 三. PA0245 ( 185 ) Arteriovenous malformation, cerebrum, left frontal lobe, 17M (P.28)
* 
* **Hyalinization or fibrosis** (管壁)
* 不正常的靜脈/動脈間有**CNS gliotic tissue**
* 
* Internal elastic lamina
* 
## Skin
* 一. PA0193 (121) Seborrheic keratosis, skin (trunk), 55F (P.5)
* 脂漏性角化症
* 
* **Horn cyst** (塞keratin的cyst) & invagination cyst (表面折進去)
* 
* 
* 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
* 
* 
* 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
* 
* 三. PA0139 (115) Bullous pemphigoid, skin (ankle), 91F (P.45)
* 
* 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)
* 
* **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
* 
* hyperkeratosis
* Sawtooth appearance: rete ridges往下長破碎細尖
* hypergranulosis: wedge-shaped顆粒層增生
* 
## Bones
* 一. PA0145 (122) P.4 Osteopetrosis, bone (femur), 47M
* 
* 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**
* 
* 三. PA0147 (174) P.24 Chondrosarcoma, bone (phalanx), 34M
* 
* **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
* 
* **Lace-like Osteoid matrix**: 方向差不多 (c.f. Fibrous dysplasia)
* Dysplasia:
* 核大黑
* tumor giant cell (多核)
* 

|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
* 
* 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
* 
* hemosiderin
* degeneration: cystic (次級aneurysmal bone cyst), fibrosis, ossification (形成woven bone)
* 七. PA0151 (121) P.82 Fibrous dysplasia, bone, 39F
* 
* Woven bone: **disoriented**: 像中文字 (**Chinese character**)
* **Fibrous background**: fibroblastic proliferation
* 
* 八. PA0152 (128) P.95 Tenosynovial giant cell tumor, diffuse type (**PVNS**, pigmented villonodular synovitis), joint (knee), 57F
* 
* **Villous & nodular** components
* **Hemosiderin**
* Synoviocyte (**小單核histiocytoid**, villi內部, foamy [核沒有被推到一邊])
* 
* 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
* 
## Diseases of soft tissue
* 一. PA0157 ( 133 ) Synovial sarcoma, soft tissue ( foot ) , 37M
* Biphasic: Monophasic + epithelial component
* 
* **單調spindle cells**: 多、N/C高、核靠在一起、**核卵長狀、short fascicles**
* 
* 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)
* 
* 二. PA0256 ( 189 ) Dedifferentiated liposarcoma, thigh, 58M
* **Non-lipogenic** (有有fat之處也有沒fat之處=>dedifferentiated)
* 
* **Pleomorphism明顯、N/C高**
* 
* 

## 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;<br> N2b, 多顆|N2c, 多顆|N3b|
|>6|N3a|N3a|N3b|