# Patho Micro Block IIb
## Endocrine (1)
* 一. PA0126 (104) Nodular goiter, thyroid gland, 43F(P.3)
* multiple size-varied colloid nodules
* **thin fibrous capsule**. cf. follicular adenoma: 一顆, fibrous capsule完整且厚
* Sanderson's polster: 大follicle裡面有很多secondary follicles
* 二. PA0259 (105) Papillary carcinoma, thyroid gland, 18F (P.20)
* ill-defined
* **papillary 細**
* **Orphan Annie eye 核空亮**??
* **grooving**
* pseudoinclusion
* Psammoma body (papilla中間)
* 
* microfollicle
* lymph node invasion
* 三. PA0128 (106) Hashimoto’s thyroiditis, thyroid gland, 67F(P.46)
* **Hürthle cell change:** 大、粉紅色細胞質、大核、明顯核仁
* Dense inflammation: **germinal center**
* 四. PA0223 (164) Subacute granulomatous thyroiditis, thyroid gland, 38F(P.55)
* 低倍較紅
* fibrosis
* **follicles破壞、PMN聚集** (microabscess, histiocytes, multinucleated giant cells)
* 五. PA0224 (165) Medullary carcinoma, thyroid gland,52F (P.69)
* NET, parafollicular C cell
* Architecture:
* well-defined, 有occasional germinal center
* **Acellular Amyloid** (相較於fibrosis顏色較淡)
* 
* Cytology
* 細胞多角形, plasmacytoid或spindled, 細胞邊界不清
* salt-and-pepper chromatin
* 六. PA0225 (166) Diffuse hyperplasia (Graves’ disease), thyroid gland, 29F(P.85)
* **Papillary infolding**: follicle內折
* 看不太到colloid
* 
* follicular cell activated:
* 柱狀
* colloid被吃掉: **scalloped margins**
* lymphocytic infiltrate
## Endocrine (2)
* 一. PA0135 Adamantinomatous craniopharyngioma, cerebrum ( suprasella ) , 30F
* **peripheral (nuclear) palisading**
* **星芒狀**：Central spongy stellate reticulum
* **Wet keratin 鱗狀上皮成團**、核殘存 (shadow)
* 
* <details>
<summary><b>myxoid stroma</b>, perivascular edema</summary>
<img src=https://i.imgur.com/ppcikMi.jpg></img>
<img src=https://i.imgur.com/hKvRrvf.jpg></img>
</details>
* 二. PA0134 Pituitary adenoma, pituitary gland, 71M
* **papillary**, nesting
* cyst, dilated close acini (anastomosing cords)
* Uniform polygonal cells: nest
* columnar: fibrovascular
* 三. PA0133 (109) Adrenocortical adenoma, adrenal gland, 51F
* well-defined, 薄薄fibrous capsule
* trabeculae (zona fasciculata), **nest (zona glomerulosa)**: nesting pattern
* **foamy (lipid)**, 核圓圓小小
* 四. PA0132 Pheochromocytoma, adrenal gland, 26M
* **Nesting pattern (zellballen)**: 細胞核大、細胞質紫灰紅、salt and pepper chromatin
* alveolar pattern: nesting中間空掉
* 五. PA0130 Parathyroid adenoma, parathyroid gland, 74M
* 
* **Chief cell**: central nuclei, 細胞質空亮 (water clear, glycogen)
* 束狀排列、**沒有脂肪粒**、有時有acinar arrangement
* endocrine atypia: 核變大黑糊成一團
* oxyphil cell
* 六. PA0080 (64) Neuroendocrine tumor (islet cell tumor), pancreas, 52M
* 在islet of Langerhans, trabeculae/ribbon-like
* Eosinophilic, 紫色的, 核圓、N/C高, stippled chromatin
* 
## Hematopoietic system (1)
* 一 . PA0010 (12) Bone marrow (without specific change) , bone marrow, 32F (P.3)
* <details><summary>Normal Megakaryocyte</summary><img src=https://i.imgur.com/NDGwm3P.jpg></img></details>
* <details><summary>Normal erythroid</summary><img src=https://i.imgur.com/cZyn1wf.jpg></img></details>
* <details><summary>Normal myeloid lineage</summary><img src=https://i.imgur.com/kKSth8H.jpg></img><img src=https://i.imgur.com/yFPztXW.jpg></img></details>
* 二 . PA0014 (16) Aplastic anemia, bone marrow, 14M (P.14)
* Hypocellularity: adipose stroma
* Serous exudate: acute inflammation
* 三 . PA0012 (14) Acute myeloid leukemia, bone marrow, 28F (P.18)
* 
* Hypercellular, monomorphic
* AML/ALL = Acute Leukemia
* All blasts, 核仁明顯
* 四 . PA0009 (11) B-acute lymphoblastic leukemia, bone marrow, 16M (P.23)
* 
* cytoplasm較少、核仁不明顯
## Hematopoietic system (2)
* 一. PA0013 (15) Chronic myeloid leukemia, bone marrow, 64F (P.3)
* Polymorphic
* 
* <details><summary>Myeloid of various stages</summary>
<img src=https://i.imgur.com/lHyourz.jpg></img>
</details>
* Eosinophilic
* <details><summary><b>“Dwarf” megakaryocytes: 看到很多核不黑、lobulation不明顯,是dysplastic megakaryocyte</b></summary>
<img src=https://i.imgur.com/i23zJCf.jpg></img>
<img src=https://i.imgur.com/8VS94Vc.jpg></img>
</details>
* 二. PA0005 (7) (Follicular) lymphoid hyperplasia, lymph node, 44F (P.14)
* **T-zone (paracortex) hyperplasia**: 點狀、被咬的感覺、有藍有白、mouse-eaten pattern
* 
* Germinal center (cortex) **mantle zone明顯**
* <details><summary><b>Tingible macrophages</b></summary><img src=https://i.imgur.com/eIthIOj.png></img><img src=https://i.imgur.com/yv9OruP.jpg></img></details>
* Dilated sinusoid塞滿histiocytes
* 三. PA0006 (8) Follicular lymphoma, lymph node, 46F (P.27)
* Nodular pattern: follicles **back-to-back**, no mantle zone, tingible macrophages, nor polarity ←→ Lymphoid Hyperplasia
* 
* **small cell**: low grade, **centrocytes核小黑不規則**
* 四. PA0258 (175) Classical Hodgkin lymphoma, lymph node (P.43)
* architecture effacement: diffuse or vague nodules
* 
* **Reed-Sternberg cells**: 細胞大、核大、核仁大、**有分葉**
* Hodgkin cells (mononuclear RS): 細胞大、核大、核仁大、無分葉, **貓頭鷹眼睛**
* <details><summary>RS vs. MRS</summary><img src=https://i.imgur.com/VCu4BTg.jpg></img></details>
* lacunar RS cells: pale cytoplasm
* mixed T cells, **eosinophils**
## Hematopoietic system (3)
* 一. PA0235 (176) Diffuse large B cell lymphoma, tonsil, 62F (P.4)
* lymphoid, > histiocyte, pleomorphic nucleus 比較大核比較淡有明顯核仁
* 像immunoblast（核仁中間一顆）, centroblast（核仁黏在核周多顆）, RS cell
* **Diffuse infiltration**
* 二. PA0237 (177) Burkitt’s lymphoma, fallopian tube, 12F ,(P.16)
* small cell, non-cleaved nucleus
* uniform小圓核，多paracentric核仁?，染色質濃縮
* diffuse, starry sky (tingible body macrophages)
* 三. PA0011 (13) Plasma cell myeloma (multiple myeloma) , bone marrow, 52M ,(P.25)
* 紫, hypercellularity
* Plasmacytosis (偏心）
* 四. PA0042 (172) Lymphoid hyperplasia (chronic tonsillitis) , tonsil, 6M ,(P.32)
* crypt lining squamous epithelium: lymphoid cells堆在皮下 → tonsil
* colonized **actinomycetes**
* Lymphoid follicle:
* **Polarized mantle zone**,
* germinal center有**dark/light zone**
* 
* tingible body macrophages
* Small, cleaved nuclei (核多摺痕凹陷): centrocytes: light zone
* open chromatin, peripheral multiple nucleoli: centroblasts: dark zone