---
# System prepended metadata

title: Patho Micro Block IIb

---

# 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)
    * ![](https://i.imgur.com/zUnAxv5.png)
    * 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)
        * ![](https://i.imgur.com/59BAAhm.jpg)
    * 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
    * ![](https://i.imgur.com/dYBZCxS.jpg)
    * 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)
    * ![](https://i.imgur.com/pqHQm9I.jpg)
    * <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
    * ![](https://i.imgur.com/Vs5ddH4.jpg)
    * **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
    * ![](https://i.imgur.com/NnMF6YK.jpg)
## 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)
    * ![](https://i.imgur.com/oTyJ9lL.jpg)
    * Hypercellular, monomorphic
    * AML/ALL = Acute Leukemia
    * All blasts, 核仁明顯
* 四 . PA0009 (11) B-acute lymphoblastic leukemia, bone marrow, 16M (P.23)
    * ![](https://i.imgur.com/0R9xm8L.jpg)
    * cytoplasm較少、核仁不明顯
## Hematopoietic system (2)
* 一. PA0013 (15) Chronic myeloid leukemia, bone marrow, 64F (P.3)
    * Polymorphic
    * ![](https://i.imgur.com/HkMNxWE.jpg)
    * <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
    * ![](https://i.imgur.com/3xhxcoF.jpg)
    * 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
    * ![](https://i.imgur.com/c9Z3RAB.jpg)
    * **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
    * ![](https://i.imgur.com/idVI6Ca.jpg)
    * **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**
        * ![](https://i.imgur.com/rTLbXZ9.png)
    * tingible body macrophages
    * Small, cleaved nuclei (核多摺痕凹陷): centrocytes: light zone
    * open chromatin, peripheral multiple nucleoli: centroblasts: dark zone