Contributed by Miralem Mrkonjic, M.D., Ph.D.
Left breast mass with nonmass enhancement
Images hosted on other servers:
Doppler ultrasound, molybdenum target
MRI and PET / CT
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Ill defined, slightly lobulated mass
Gray-brown rubbery tumor
Contributed by Miralem Mrkonjic, M.D., Ph.D.
Infiltrative growth pattern
Microglandular architecture
Microglandular architecture and eosinophilic cytoplasm
Areas resembling
invasive ductal
carcinoma of no
special type
Prominent cytoplasmic eosinophilic granules
Background of extensive MGA and AMGA
MGA in the adipose tissue
Nuclear atypia in MGA
Absence of staining around invasive carcinoma
Invasive carcinoma is negative for ER
Invasive carcinoma is negative for HER2
Invasive carcinoma is positive for S100
Invasive carcinoma is positive for lysozyme
PASD cytoplasmic staining
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Cytoplasmic electron dense granules
Dilation of RER
Acinar cell granules, prominent RER
Contributed by Kristen E. Muller, D.O.
Ultrasound hypoechoic process
Ultrasound irregular fluid collection
Contributed by Ayesha Farooq, M.B.B.S. and Julie Jorns, M.D. (Case #515)
Nipple piercing related infection
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Mastitis and breast abscess
Lactational abscess
Contributed by Kristen E. Muller, D.O.
Acute mastitis and abscess
Lobular inflammation
Dense inflammatory infiltrate
Dense neutrophilic infiltrate
Contributed by Ayesha Farooq, M.B.B.S. and Julie Jorns, M.D. (Case #515)
Nipple piercing related infection
Contributed by Mark R. Wick, M.D.
Mammogram
Images hosted on other servers:
MRI
Contributed by Gary Tozbikian, M.D.
Extensive cribriform architecture, infiltrative growth pattern
Dual population of basaloid and epithelioid cells
Estrogen receptor
p40
CD117 / KIT
Contributed by Mark R. Wick, M.D.
FNAB
Images hosted on other servers:
Papanicolaou
Monomorphic tumor cells around mucoid material
Contributed by Dr. Semir Vranic
AFIP images
Solid pattern with
inconspicuous
cylindromatous
elements at arrows
Contributed by Dr. Hind Nassar, Johns Hopkins Medical Center, Maryland (USA):
Various images
p63
Actin
Contributed by Dr. Semir Vranic, University of Sarajevo, Bosnia and Herzegovina:
Core biopsy
Low power
Low power
Medium power
High power
High power
Images hosted on other servers:
Left breast
Hypoechoic mass
Irregular spiculated dense mass
Spiculated hypoechoic mass
Contributed by Julie M. Jorns, M.D. and Kristen E. Muller, D.O.
Adenomyoepithelial adenosis
Adenomyoepithelial adenosis
p63
Calponin
Contributed by Melissa Krystel-Whittemore, M.D. and Mark R. Wick, M.D.
Mammogram, irregular mass
Ultrasound, hypoechoic mass
Mammogram
Contributed by Melissa Krystel-Whittemore, M.D., Case #418
Tan-gray mass
Malignant adenomyoepithelioma
Contributed by Hannah Y. Wen, M.D., Ph.D.
Circumscribed lobulated tumor
Myoepithelial cells surrounding glands
Compressed tubules
Hyaline-like basement membrane
Calponin
p63
Contributed by Fresia Pareja, M.D., Ph.D.
Malignant adenomyo-
epithelioma
Biphasic epithelial and myoepithelial proliferation
Nuclear atypia and mitoses
Fat invasion
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MYC amplification
Contributed by Julie M. Jorns, M.D.
Simple adenosis
Tubular adenosis
Nodular adenosis
What is adenosis?
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Bilateral athelia
Amastia (before reconstruction)
Amastia (after implant)
Amastia (after NAC reconstruction)
Polythelia
Contributed by Reena Tomar, M.B.B.S., M.D. and Julie M. Jorns, M.D.
Hypoplasia
Hypoplasia
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Figure 7: Flow chart for diagnosis of amyloidosis
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Figures 1 and 2
Amyloid tumor
Thioflavin T stain
Parenchyma - Congo red
Thick wavy bands of
amyloid around lobular
glands and a nodular deposit
that is virtually acellular
Amyloid occurs in
lobule (lower left) and
as separate stromal
nodule (upper right)
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Various images
Amyloid with osseous metaplasia
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Dense hyaline material and giant cells
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Milk lines
Breast anatomy
Regional lymph nodes - schematic
Radical mastectomy
Supraclavicular fossa
Radiograph of lymphatics
Tracing of lymphatics
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Nipple orifices, some cannulated with guide wires
AFIP images
Premature thelarche (9 year old girl)
Proliferation of ducts without lobules
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Perforating lymphatic
Instillation of
water insoluble and
differently colored
dyes in orifices
Contributed by Melinda J. Lerwill, M.D.
Postradiation angiosarcoma arising in the skin
Postradiation angiosarcoma of the breast parenchyma
Contributed by Mark R. Wick, M.D.
Postradiation angiosarcoma
Contributed by Melinda Lerwill, M.D. and Mark R. Wick, M.D.
Postradiation angiosarcoma
Postradiation angiosarcoma
Contributed by Melinda Lerwill, M.D.
Low grade primary angiosarcoma
Irregular vessels
Infiltrative growth
Postradiation angiosarcoma
High grade cytologic atypia
Solid growth
Epithelioid cells
Blood lake
ERG
MYC
Contributed by Sofia Lérias, M.D.
Atypical spindle cells
Postradiation angiosarcoma
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Mechanism of action of antibody drug conjugates
Contributed by Jonathan Marotti, M.D.
Mammogram
Ultrasound
Contributed by Jonathan Marotti, M.D.
Large atypical epithelial cells
AR positive
ER negative
PR negative
Large atypical epithelial cells
AR positive
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Cytoplasm rich in organelles
Electron dense granules
Contributed by Julie M. Jorns, M.D.
Distortion, apocrine features
Apocrine features
Distortion, cytologic atypia
Cytologic atypia
Contributed by Volodymyr Shponka, M.D.
Fine needle aspiration
Contributed by Carlos C. Diez Freire, M.D.
Dilated eosinophilic glands
Papillary projections
Abundant cytoplasm
Early apocrine metaplasia and p63
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Atezolizumab blocks PDL1 on tumor cells
Inhibition of PDL1 through STAT3 / caspase 7 signaling
(a,c) Crystals of PDL1 with atezolizumab
Contributed by Julie M. Jorns, M.D.
Cribriform
Small foci with cribriforming and monotony
Polarization
Bridges with uniform thickness
Cribriform and solid
Solid growth
Micropapillary
Short papillae
Partial gland involvement
Contributed by Eric Statz, M.D., Julie M. Jorns, M.D. and Azadeh Khayyat, M.D. (Case #533)
ALH in fibroadenoma
ALH in fat
Plasmacytoid ALH
Duct with ALH
Lobule expanded by ALH
ALH full lobule
Loss of E-cadherin
Loss of E-cadherin ALH / LCIS
Ductal carcinoma in situ (DCIS), solid type, with microcalcifications, confined to a fibroadenoma; lobular neoplasia (atypical lobular hyperplasia / lobular carcinoma in situ), with involvement of a fibroadenoma
Contributed by Anna Purdy, M.S.N.
Upper outer quadrant erythema
Axillary papules
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Postmastectomy
Left breast is erythematous with sclerotic tissue changes
Papules and nodules around the mastectomy scar
Contributed by Indu Agarwal, M.D., Sharlene See, M.D. and Julie M. Jorns, M.D.
Wedge shaped outline
Flat to plump endothelial cells
Vascular channels
Excision specimen
Papule
Skin punch biopsy
Skin punch biopsy (CD31)
Skin punch biopsy (c-MYC)
Contributed by Mary Ann G. Sanders, M.D., Ph.D.
Benign squamous epithelial inclusion
Benign glandular epithelial inclusion
PAX8
Treatment effect
Pankeratin
Matted lymph nodes
Extranodal extension
Contributed by Di Ai, M.D., Ph.D., Kristen E. Muller, D.O. and Samantha A. Stephen, D.O. (Case #530)
Chest Xray
Contributed by Di Ai, M.D., Ph.D.
Ruptured silicone breast implants
Contributed by Di Ai, M.D., Ph.D., Julie M. Jorns, M.D., Kristen E. Muller, D.O. and Samantha A. Stephen, D.O. (Case #530)
Synovial metaplasia
Synovial metaplasia
Synovial metaplasia CD68
Synovial metaplasia vimentin
Synovial metaplasia AE1 / AE3
Silicone leakage
Silicone granuloma
Silicone leakage
Contributed by Emily S. Reisenbichler, M.D.
Biopsied area with marker placement
Biopsy clips with localization wires
M shaped and top hat clips
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Lost biopsy marking clips (arrows)
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Devices and radiographs (various images)
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Biopsy clips may be much smaller than standard surgical clips
Contributed by Emily S. Reisenbichler, M.D., Kristen Liu, M.D. and Julie Jorns, M.D. (Case #539)
Acellular hyalinized collagen plug
Gel material and central hemorrhage
Gel material resembling suture material
Prominent multinucleated giant cell reaction
Lymph node with benign epidermal inclusion cyst and biopsy site changes, negative for carcinoma
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Breast cancer predisposition genes
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Mammogram and USG findings
Circumscribed hypoechoic mass with BRCA1 mutation
Irregular obscured isodense mass
Hypoechoic, irregular shape, calcifications in BRCA2
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Mass in BRCA positive man
Contributed by Kristen E. Muller, D.O. and Chanchal Rana, M.D.
Well demarcated pushing borders
High grade nuclear features
Lymphoplasmacytic
infiltration
Syncytial growth with necrosis
ER negative
PR negative
HER2 neu negative
Ki67
p53 expression
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BRCA pedigree
LGRs BRCA1
LGRs BRCA2
MYC amplification
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Anaplastic large cell
lymphoma cells in
seroma and within
fibrous capsule
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Clinical presentation / intraoperative appearance
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Breast capsule
Contributed by Dia Kamel, M.D., Ph.D.
Breast capsule
Pleomorphic cells
CD30
EMA
ALK1
CD4
Contributed by Andrii Puzyrenko, M.D., Ph.D. and Julie Jorns, M.D. (Case #512)
Capsule
Aspirated fluid
Contributed by Dia Kamel, M.D., Ph.D.
Cell block
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2D: PCR studies
Cytogenetic studies
Update on plastic surgery of anaplastic large cell lymphoma
Contributed by Dr. Mark R. Wick
Mammogram
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Irregular mass (mammography), hypoechoic area (ultrasound)
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Carcinoma en cuirasse
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Anal metastasis
Contributed by Joshua J.X. Li, M.B.Ch.B., Gary M. Tse, M.B.B.S and Kristen E. Muller, D.O.
Tumor cells in single file
Low grade nuclei
Adjacent in situ component
E-cadherin loss
Intracytoplasmic vacuoles
Luminal A subtype
Alveolar pattern
Signet ring pattern
Solid pattern
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S
Discohesive tumor cells
Mild atypia
Loose chains of cells
Intracytoplasmic vacuolation
Contributed by Iskender Sinan Genco, M.D. and Sabina Hajiyeva, M.D.
Cribriform architecture
Multiple ducts
2 different sized ducts
Cribriform architecture
Partial involvement
Adjacent apocrine metaplasia
Columnar cell changes
Smooth muscle myosin heavy chain
CD10
KIT / CD117
In situ carcinoma
ER
CK5/6
Adjacent invasive carcinoma
Smooth muscle actin
Smooth muscle myosin heavy chain
Calponin
p63
PAS
Contributed by Mark R. Wick, M.D.
FNA
Breast calcifications
Contributed by Jonathan Marotti, M.D.
Calcifications associated with columnar cell change / hyperplasia
Contributed by Jonathan Marotti, M.D.
Dilated TDLU
Flocculent secretions
Columnar cells
Irregular TDLU
Calcifications
Tufts / mounds
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Mammotome
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Displaced epithelial cells; #2 - intracystic papillary carcinoma
Detached clusters
of ductal carcinoma
in situ from
pre-existing ducts
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Mammogram: 2.5 cm tumor, fuzzy border
Contributed by Sunitha Shankaralingappa, M.B.B.S, M.D., D.M.
Epithelial cells in cribriform pattern
Pure ICC
Low grade, cribriform pattern, mucin
Low grade nuclei
Cribriform carcinoma with cribriform DCIS
Cribriform DCIS with invasive component
Cribriform DCIS
IHC: ER strongly positive
IHC: PR strongly positive
IHC: HER2 negative
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Large sheets, cribriform architecture
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Numerous cysts with a gelatinous secretion
Contributed by Andrew P. Sciallis, M.D. and Kristen E. Muller, D.O.
Conspicuous intraluminal pink secretion
Contrasting cytomorphology
CHH lacks atypia
Cytologic atypia in atypical CHH
Micropapillary
architecture and
pseudostratification
Prominent micropapillary architecture
Nuclear hyperchromasia and nucleoli
High grade, triple negative invasive ductal carcinoma
ER expression
Contributed by Victoria M. Jones, M.D., Kristen E. Muller, D.O., AFIP and Lisa Cerilli, M.D. (Case #35)
Multiple dilated cysts
Pregnancy-like changes
Colloid-like secretions
Bland, simple cuboidal epithelial lining
Atypia
Atypia
CHC (DCIS)
Cysts lined by flat, cuboidal epithelium
Cysts lined by flat, cuboidal epithelium
Focal atypical epithelium
Intraluminal secretions
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Palpable breast mass
Contributed by Jessie M. Wu, M.B.Ch.B. and Gulisa Turashvili, M.D., Ph.D.
Mixed inflammation
Lipid vacuoles
Gram stain
Contributed by Ankur Sangoi, M.D. (Case #462)
Mixed inflammation
Lipid vacuoles
Gram stain
Contributed by Areej M. Al Nemer, M.D.
Benign epithelial clusters (C2)
Granulomatous inflammation (C2)
Fibrocystic change (C2)
Lactational changes (C2, false positive diagnosis is a possible pitfall)
Lactational changes (C2)
Fibroadenoma (C2, 5 images)
Phyllodes tumor (C2 / C3)
Phyllodes tumor (C2 / C3)
Suspicious nipple
discharge (C4):
invasive & in situ
apocrine carcinoma
Suspicious nipple discharge (C4): juvenile papillomatosis
Malignant (C5): invasive carcinoma of no special type
Malignant (C5): invasive lobular carcinoma
Malignant DCIS (C5)
Contributed by Azadeh Khayyat, M.D. and Julie M. Jorns, M.D. (Case #533)
Mammogram
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Microcalcifications detected by mammography and tomosynthesis
Microcalcifications detected by mammography
Irregular mass via ultrasound
MRI of an irregular mass
MRI of a linear enhancement
Contributed by Gary Tozbikian, M.D., Azadeh Khayyat, M.D. and Julie M. Jorns, M.D. (Case #533)
Low grade, cribriform
Intermediate grade, cribriform
Intermediate grade, papillary and cribriform
Intermediate grade, papillary
Intermediate grade, solid
Intermediate grade, micropapillary
High grade, flat
High grade, solid
High grade, solid and cribriform
High grade, solid and cribriform
Ductal carcinoma in situ (DCIS), solid type, with microcalcifications, confined to a fibroadenoma; lobular neoplasia (atypical lobular hyperplasia / lobular carcinoma in situ), with involvement of a fibroadenoma
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Low grade
High grade
Contributed by Carlos C. Diez Freire, M.D.
Dilated ducts with foamy macrophages
Dilated ducts with foamy macrophages
Garland sign
Contributed by Thomas Lienhoop, M.D.
Screening mammogram
Diagnostic ultrasound
Contributed by Susanne M. Crespo-Ramos, M.D., Anna Biernacka, M.D., Ph.D. and AFIP
Epithelial cell nests and glands
Compressed glands
Well circumscribed adenomatous nodule
Duct wall / capsule
Duct distention and pseudoinvasion
Pseudoinfiltrative and pushing borders
Glands and stroma
Epithelial and myoepithelial cells
Eosinophilic secretions
Usual ductal hyperplasia
Central fibrosis, peripheral bland ducts
Nodular lesion, primarily spindle cells
Spindle cells with residual ducts
Spindled myoepithelial cells around peripheral duct
Ducts lined by apocrine cells
Smooth muscle myosin
p63
Cytokeratin 5/6
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Myoepithelium and hormone receptors in EPC
Contributed by Mariel Molina Nunez, M.D. and Julie Jorns, M.D. (Case #518)
Mammogram of the left breast mass
Ultrasound view of the complex mass
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Mammographic, sonographic and MRI findings
Mammographic findings
Mammographic findings
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Papillary tumor within cystic space
Solid tumor within cystic duct
High grade EPC with hemorrhage
Contributed by Kristen E. Muller, D.O. , Mariel Molina Nunez, M.D. and Julie Jorns, M.D. (Case #518)
Encapsulated papillary carcinoma with invasion
Synaptophysin
EPC, circumscribed with fibrous capsule
Low grade nuclear atypia
EPC with invasion
EPC with DCIS and invasion
High grade EPC
Estrogen receptor (ER)
Absent myoepithelium
Progesterone receptor (PR)
Thick fibrous capsule encircles mass
Surrounding encapsulation and cystic space
Fibrovascular cores within epithelial proliferation
Loss of E-cadherin in the lesion
Papillary lesions of the breast
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Contraction
and
microcalcification
Fat necrosis within surgical site
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Skin and fat necrosis due to methylene blue
Contributed by Elizabeth Abels, M.D.
Fat necrosis within biopsy site
Contributed by Jing He, M.D.
Disruption of adipocytes
Mixed inflammation
Mixed inflammatory cells
Hemorrhage and hemosiderin
Hemosiderin and giant cells
Multinucleated giant cells
Lipid laden histiocytes and hemorrhage
Lipid laden histiocytes
Mass formation
Necrotic adipocytes
Cystic degeneration
Early fibrosis
Oil cyst
Late stage fibrosis
Eggshell calcifications
CD68
AE1 / AE3
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Stages of fat necrosis
Breast traumatic fat necrosis
Breast inflammatory conditions
Contributed by Mark R. Wick, M.D., Azadeh Khayyat, M.D. and Julie M. Jorns, M.D. (Case #533)
Mammogram
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Juvenile fibroadenoma
Contributed by Gary Tozbikian, M.D.
Well circumscribed tumor with bulging cut surface
Contributed by Gary Tozbikian, M.D., Debra Zynger, M.D., Azadeh Khayyat, M.D. and Julie M. Jorns, M.D. (Case #533)
Fibroadenoma
Fibroadenoma
Complex fibroadenoma
Myxoid fibroadenoma
Juvenile fibroadenoma
Cellular fibroadenoma
Fibroadenoma with ALH
Fibroadenoma with atypical ductal hyperplasia
Fibroadenoma with atypical ductal hyperplasia
Multinucleated stromal cells
Ductal carcinoma in situ (DCIS), solid type, with microcalcifications, confined to a fibroadenoma; lobular neoplasia (atypical lobular hyperplasia / lobular carcinoma in situ), with involvement of a fibroadenoma
Contributed by Areej M. Al Nemer, M.D.
Branching sheets
Bare nuclei
Bland stromal fragments
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Diff-Quik
Pap
Fibroadenoma
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Well circumscribed nodule
Suspicious granular microcalcifications
Contributed by Melissa Alexander, M.D., Ph.D.
Edges blend with surrounding tissue
Vague stromal nodularity
Poorly circumscribed
Background fibrocystic change
Multiple nodules
Multiple nodules
Loose versus dense hyalinized stroma
Dense stroma
Loose versus dense nodules
Loose stroma, compressed glands
Fibroadenomatoid nodule, compressed glands
Contributed by Carissa LaBoy, M.D.
Mammogram of right breast
Ultrasound of right breast
Mammogram of breast mass
Ultrasound of left breast
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White trabeculated cut surface
Chest wall mass
Contributed by Carissa LaBoy, M.D.
Infiltrative breast mass
Cells entrapping normal ducts
Cells in collagenous stroma
Bland spindle cells
Positive margin on excision
Beta catenin positivity
Beta catenin nuclear positivity
CD34 negative spindle cells
Pancytokeratin negative spindle cells
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Fine needle aspiration of fibromatosis
Fine needle aspiration of fibromatosis
Review of fibromatosis
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Mammogram, microlobulated high density mass
Ultrasound, hypoechoic mass
MRI, irregular mass with heterogeneous enhancement
Contributed by Kristen E. Muller, D.O. and Julie M. Jorns, M.D.
Fibromatosis-like metaplastic carcinoma
Squamous and glandular elements
Fascicular arrangement
Bland spindle cells
Round cells with nucleoli
Focal squamous and glandular elements
Infiltrative border
p63
CK MNF 116
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Fibroblastic, myoepithelial and epithelial features
Contributed by Julie M. Jorns, M.D. and Shadie Majidi, M.D.
Calcifications corresponding to FEA
Calcifications, craniocaudal view
Calcifications, mediolateral view
Contributed by Julie M. Jorns, M.D.
Bluer appearance
Luminal secretions
Lack of polarity
Microcalcifications
Apocrine features
Apocrine
features and
luminal secretions
Prominent nucleoli
Contributed by Dr. Saroona Haroon, The Aga Khan University Hospital (Pakistan)
Cholesterol granuloma in 56 year old woman with 4 month history of hard immobile mass of left breast; no history of pus or blood discharge
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Asteroid body
Granulation tissue
Foreign body reaction
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Left: ice crystals in edematous stroma by frozen section, right: H&E
Nuclear ice crystals (particularly a problem with thinner sections): left - lung adenocarcinoma, right - uterine sarcoma
Glioma
Brush technique
Embedding small specimens
Speed embedding
Contributed by Emily S. Reisenbichler, M.D.
Dermal lymphovascular invasion
Invasive lobular carcinoma
Invasive mammary carcinoma
Nipple with chronic inflammation
Sclerosing adenosis
Ductal carcinoma in situ
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Infiltrating ductal carcinoma
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Cyst with circumscribed rounded margins
Oval shaped mass with hypoechoic rim
Contributed by Nasir Ud Din, M.B.B.S.
Oval multicystic lesion with well circumscribed borders
Contributed by Saba Anjum, M.B.B.S.
Multiple variable sized anastomosing cysts
Cystic lesion lined by cuboidal epithelium
Proteinaceous material
Cyst lined by cuboidal epithelium
Galactocele with lactational change and mild fibrosis
Contributed by Dhiraj B. Nikumbh, M.D.
27 year old woman with 1.5 cm nontender breast nodule and fine needle aspiration cytology
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Dark purple crystals in a proteinaceous background
Contributed by Mark R. Wick, M.D.
Mammogram spot film
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Fig 2, case 1:
ultrasonography
revealed a tumor
7 x 8 mm in size
Mammograph of the breast
Contributed by Mark R. Wick, M.D. and AFIP
Dense
homogenous
tumor with
infiltrating margins
Various images
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Firm tumor with irregular borders
Granular cell tumor in right breast
52 year old woman with 1 cm nodule
Contributed by Emily S. Reisenbichler, M.D., Mark R. Wick, M.D., Dr. Oleksandr Grygoruk, AFIP and @ThatGlassTho on Twitter
Infiltration into fat
S100+ tumor cells and myoepithelial cells
Granular cell tumor
Various images
Various images
S100
Granular cell tumor
9 year girl with a 2 cm granular cell tumor near the left nipple, unchanged in size over past 3 years
9 year girl with a 2 cm granular cell tumor near the left nipple, unchanged in size over past 3 years
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Core biopsy
Abundant eosinophilic, granular cytoplasm
Beneath squamous epithelium (not necessarily breast): H&E and S100
Compact nests of polygonal cells
Cells contained granular eosinophilic cytoplasm
IHC study showed reactivity for S100 protein
H&E staining of granular cells
Contributed by Mark R. Wick, M.D.
FNAB
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Digital mammography and ultrasound
MRI
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Painless discolored lesion
Ulcerated painful lesion
Contributed by Salvatore Luceno, M.D., M.Sc. and Anna Biernacka, M.D., Ph.D.
Skin involvement
Solid mass
Contributed by Salvatore Luceno, M.D., M.Sc. and Anna Biernacka, M.D., Ph.D.
Pseudoepitheliomatous hyperplasia
Infiltration around adnexal structures
Stromal inflammatory cells
Spindly cells in fascicles
Infiltration of dermal collagen
Focal nuclear atypia
Core needle biopsy
Infiltration of fat
Abundant cytoplasm, small nuclei
Proximity to nerve
Cytoplasmic granules (lysosomes)
S100
CD68
Cytokeratin AE1 / AE3
Contributed by Salvatore Luceno, M.D., M.Sc. and Anna Biernacka, M.D., Ph.D.
Abundant and delicate cytoplasm
Granular background, naked nuclei
Resemblance to histiocytes
Nuclear features
Contributed by Elaine Zhong, M.D.
Mammogram
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Physiologic gynecomastia in puberty
Spironolactone induced
Contributed by Elaine Zhong, M.D.
Florid pattern
3 layer epithelium
Fibrous pattern
ADH in gynecomastia
DCIS in gynecomastia
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Clusters of bland, cohesive epithelial cells
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Mammographic findings
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Cut section of mammary hamartoma
Contributed by Indu Agarwal, M.D.
Mammary hamartoma
Components of mammary hamartoma
Myoid hamartoma
Myoid hamartoma, immunostain desmin
Myoid hamartoma, immunostain SMA
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Normal arterial and venous anatomy of the breast
Contributed by Indu Agarwal, M.D.
Cavernous hemangioma, ultrasound
Cavernous hemangioma, mammography
Capillary hemangioma, ultrasound
Contributed by Mark R. Wick, M.D.
Capillary hemangioma, breast skin
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Diffuse dermal angiomatosis
AFIP images
Angiomatosis composed of vessels / breast parenchyma
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Soft tissue mass with smooth external surface
Cut surface shows congestion and slit-like areas
Contributed by Indu Agarwal, M.D. and AFIP images
Cavernous hemangioma of breast
Capillary hemangioma
Perilobular hemangioma
Complex hemangioma
Angiomatosis
Histopathology breast, soft tissue - hemangioma
Contributed by Anand C. Annan, M.D., Ph.D., Doaa Atwi, M.D. and Lewis A. Hassell, M.D.
Invasive ductal carcinoma, Nottingham grade 2
HER2 score 2+
Invasive ductal carcinoma, grade 2
HER2 score 2+
HER2 IHC score 1+
Invasive ductal carcinoma with cord and tubule formation
HER2 IHC score 1+
Contributed by Terry Dunn, Ph.D.
Nonamplified HER2 FISH
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Breast cancer grade
Contributed by Julie M. Jorns, M.D.
Grade 1 invasive lobular carcinoma
Grade 1 invasive ductal carcinoma
Grade 2 invasive ductal carcinoma
Grade 3 invasive ductal carcinoma
Breast ductal carcinoma (breast cancer)
Breast cancer grading and staging
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Mastectomy specimen, anterior view
Contributed by Indu Agarwal, M.D. and @ThatGlassTho on Twitter
Terminal duct lobular unit (TDLU)
Extralobular and TDLU
Myoepithelial cells
Myoid appearance
Clear cell change
Cross section of nipple
Lactiferous duct
Lactational changes
Breast histology
Immunostain ER
Immunostain p63
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Acini
Glandular and myoepithelial cells
Shotgun histology inactive breast
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Various images
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Low grade IBC, NST
Invasive lobular carcinoma
Papillary carcinoma
Estrogen receptor
Progesterone receptor
Androgen receptor
Apocrine carcinoma
Androgen receptor
Atypical ductal hyperplasia
Estrogen receptor
Columnar cell change
Estrogen receptor
Florid epithelial hyperplasia
Estrogen receptor
Estrogen receptor low positive
Estrogen receptor low positive
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Mammogram; focal asymmetry
Ultrasound; hypoechoic tubular extensions
MRI; enhancing retroareolar mass
Contributed by Nicolas Ajkay, M.D.
IGLM with multiple
sinus tracts
opening onto skin
IGLM with response
to corticosteroids
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Appearance of second lump postbiopsy
Firm mass with multiple sinuses
Contributed by Jonathan Marotti, M.D. and Mary Ann Gimenez Sanders, M.D., Ph.D.
Lobulocentric inflammation
Multinucleated giant cells
Nonnecrotizing granulomas
Lobulocentric inflammation
Granulomas and multinucleated giant cells
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Landscape of anti-PD-1 and anti-PDL1 trials
Guidelines for TILs assessment
Contributed by Hannah Y. Wen, M.D., Ph.D.
Primary triple negative breast carcinoma
Primary triple negative breast carcinoma
Metastatic triple negative breast carcinoma to brain
Contributed by Kiran Manjee, M.D. and Julie M. Jorns, M.D.
Skin thickening and mass
Contributed by Amanda L. Kong, M.D., M.S. and Mark R. Wick, M.D.
Erythema and edema
Discoloration
Contributed by Kiran Manjee, M.D., Julie M. Jorns, M.D., Weijie Li, M.D. and AFIP
Dilated lymphatics
Dermal lymphovascular invasion
Dermal lymphovascular invasion
Dermal lymphovascular invasion
HER2 / neu
Locally advanced breast cancer
Skin punch biopsy
Infiltrative nests
Tumor emboli
Tumor in dermal lymphatics
Contributed by Mark R. Wick, M.D.
Mammogram
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Round or ovoid mass on mammogram and ultrasound
Well circumscribed
mass with
calcifications
Ductal dilatation on mammogram
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Male with nipple discharge
Contributed by Mark R. Wick, M.D.
Intracystic mass
Images hosted on other servers
Intraductal polypoid mass
Contributed by Xiaoxian (Bill) Li, M.D., Ph.D.
Minute intraductal papillomas
Papillary cores
Involved by usual ductal hyperplasia
Involved by apocrine metaplasia
Involved by ductal carcinoma in situ
Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Intraductal papilloma with DCIS immunoprofile
Intraductal papilloma with DCIS, CK5/6
Intraductal papilloma with DCIS, p63
Intraductal papilloma
Contributed by Mark R. Wick, M.D.
Invasive
Mammogram
Spot film
Spot film
Contributed by Mark R. Wick, M.D.
Fungating, breast skin
Contributed by Mark R. Wick, M.D. and @Andrew_Fltv on Twitter
Irregular stellate mass
Irregular stellate mass
Invasive breast cancer of no special type (NST)
Contributed by Julie M. Jorns, M.D., Kristen E. Muller, D.O., Gary Tozbikian, M.D. and Emad Rakha, M.D.
Invasive ductal carcinoma, grade 1
Invasive ductal carcinoma, grade 2
Invasive ductal carcinoma with necrosis, grade 3
Invasive ductal carcinoma with scattered apoptotic cells
CK5/6
Central necrosis
Central fibrosis
Adjacent normal breast
CK7
GATA3
Lobular and apocrine features, E-cadherin
Lobular and apocrine features
Lobular features
Lobular features, E-cadherin
GCDFP-15 positive invasive ductal carcinoma
GCDFP-15
Angiolymphatic invasion
Involvement of a fibroadenoma
Involvement of a fibroadenoma, p63
Microinvasion, p63
Microinvasion
Actin - muscle specific
Pseudo DCIS pattern
Calponin, pseudo DCIS pattern
Mammaglobin positive invasive ductal carcinoma
Mammaglobin
SOX10+ invasive ductal carcinoma
SOX10
p120+ invasive ductal carcinoma
p120
Invasive ductal carcinoma, grade 3
Invasive ductal carcinoma, grade 2
Invasive ductal carcinoma, grade 1
Contributed by Mark R. Wick, M.D. and Abdulaziz Mohamed, M.D.
FNAB
Diff-Quik
47 year old woman with 3 x 2 cm painless retroareolar mass and ipsilateral axillary lymphadenopathy
Contributed by Mark R. Wick, M.D. and Semir Vranic, M.D.
HER2 amp FISH
TOP2A CEP17 FISH - no gene amplification
Ductal carcinoma - breast
Breast ductal carcinoma (breast cancer)
Breast carcinoma: invasive - pathology mini tutorial
Contributed by Mark R. Wick, M.D.
Mammogram
Contributed by Mark R. Wick, M.D.
Juvenile papillomatosis
Contributed by Mark R. Wick, M.D.
Juvenile papillomatosis
AFIP images
Multiple cystically dilated ducts
Hyperplastic epithelium in dilated duct
Intraductal epithelial proliferation with necrosis
Apocrine metaplasia
of hyperplastic
intraductal
epithelium
Hyperplastic epithelium and foam cells
With sclerosing adenosis
and apocrine metaplasia
adjacent to cystically
dilated ducts
Multiple small intraductal papillomas in 15 year old girl
High power shows hyperplastic
intraductal epithelium, myoepithelial
cells are associated with the
delicate fibrovascular stalks
Contributed by Areej M. Al Nemer, M.D.
Suspicious nipple discharge
Contributed by Anas Mohamed, M.D. and Joseph Geradts, M.D.
Lobular carcinoma, low proliferation
Lobular carcinoma, low Ki67
Ductal carcinoma, low proliferation
Ductal carcinoma, low Ki67
Ductal carcinoma, intermediate proliferation
Ductal carcinoma, intermediate Ki67
Ductal carcinoma, high proliferation
Ductal carcinoma, high Ki67
Contributed by Kristen E. Muller, D.O.
Well circumscribed hypoechoic mass
Hypoechoic mass with hypervascularity
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Large mass
Contributed by Dr. Mark R. Wick
Lactating adenoma
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Well circumscribed mass
Contributed by Kristen E. Muller, D.O.
Lactating adenoma biopsy
Vacuolated cytoplasm
Hypersecretory features
Delicate stroma
Prominent hobnailing
Psammomatous calcification
Contributed by Dr. Mark R. Wick
FNAB
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Increased lobular size
Cytoplasmic vacuoles and background foamy material
Contributed by Kristen E. Muller, D.O. and Victoria M. Jones, M.D.
Mammographic calcifications
Contributed by Kristen E. Muller, D.O. and Victoria M. Jones, M.D.
Florid LCIS with mass-like architecture
Single acinus
Little intervening stroma
Necrosis
Calcifications
Type B cells
Type A cells
Mitoses
Apocrine features
Invasive lobular carcinoma
E-cadherin
Lobular carcinoma in situ and high risk breast lesions
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50 year old woman screening mammogram
54 year old woman screening mammogram
Contributed by Anna Biernacka, M.D., Ph.D.
PLCIS with central necrosis and calcifications
Marked nuclear pleomorphism
Cellular dyscohesion and pleomorphism
Apocrine PLCIS
PLICS, solid proliferation of discohesive cells
PLICS, absent E-cadherin
PLCIS, attenuated E-cadherin
CLCIS and PLCIS
PLCIS with associated invasive carcinoma
PLCIS within the lobule
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Cytoplasm
Nuclei
E-cadherin
Lobular carcinoma in situ and invasive lobular carcinoma including variants
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Well defined, circumscribed, hypoechoic mass
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1 cm nodule (black arrow) on left areola
Left nipple (white arrow), nodule (black arrow)
Swollen left nipple compared with the right nipple
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Well circumscribed skin covered mass
Contributed by Reena Tomar, M.B.B.S., M.D., Mark R. Wick, M.D. and Julie M. Jorns, M.D.
Dermal circumscribed leiomyoma
Spindle shaped cells
Fascicles
Whorls and fascicles
SMA
Caldesmon
Desmin
PR
S100
Fascicles
Breast core biopsy
Breast core biopsy
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Classic LCIS ultrasound
Classic LCIS mammogram
LCIS MRI
Contributed by Anna Biernacka, M.D., Ph.D.
Classic LCIS involving terminal duct lobular units
Classic LCIS, terminal duct lobular unit expansion
Classic LCIS, cell morphology
Lobular distension
Pagetoid spread, cloverleaf pattern
Pagetoid spread in ADH
Preserved lobular architecture
Type A cells
Type B cells
Type A and B cells
LCIS, mixed cell population
Signet ring cells, breast type
Signet ring cells, gastric type
Histiocytoid appearance
Clear cell change
LCIS involving an intraductal papilloma
LCIS in intraductal papilloma
Rosen triad
LCIS in collagenous spherulosis
LCIS in sclerosing adenosis
LCIS, sclerosing adenosis, calcifications
LCIS, E-cadherin
LCIS and ILC,
E-cadherin
LCIS and ILC, p63
LCIS, ER
LCIS and DCIS, low grade
LCIS versus DCIS, nucleoli
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Cytology classic LCIS
Histopathology breast: lobular carcinoma in situ
Lobular carcinoma in situ and invasive lobular carcinoma
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Mammogram: asymmetry
Mammogram: calcifications
Mammogram: mass
Ultrasound: mass
Contributed by Paula S. Ginter, M.D.
Excisional biopsy of mass
Contributed by Paula S. Ginter, M.D.
Glands and squamous nests
Bland cytology
Spindle stroma
Lymphoid aggregates
Luminal keratin debris
Associated papilloma
Myosin: variable myoepithelial staining
p63: variable myoepithelial staining
CK7: core staining
ER negative
Contributed by Kristen E. Muller, D.O.
Acoustic shadowing
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Dense white fibrous stroma
Firm white cut surface
Contributed by Kristen E. Muller, D.O.
Dense fibrous stroma
Perivascular lymphocytic inflammation
Enlarged myofibroblasts
Fibrous stroma, periductal and perivascular inflammation
Periductal lymphocytes
Epithelioid myofibroblasts
CD20
CD3
Contributed by Mark R. Wick, M.D. and Julia Braza, M.D.
Mammogram, large cell lymphoma
Mammogram, lymphoblastic lymphoma
Mammogram, CLL / SLL
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Mammogram and ultrasound, DLBCL, 47 yo
Mammogram and ultrasound, DLBCL, 56 yo
T1w MRI, DLBCL, fat suppressed
MRI, MALT lymphoma, 56 yo
Contributed by Mark R. Wick, M.D.
Large cell lymphoma
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Burkitt lymphoma
DLBCL
Large cell lymphoma
Contributed by Mark R. Wick, M.D. and AFIP images
Large cell lymphoma
Follicular lymphoma
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DLBCL
Contributed by Gary Tozbikian, M.D. and Julia Braza, M.D.
Marginal zone lymphoma
Invasion of adipose
Follicular colonization
Monocytoid-like B cells
DLBCL, activated B cell type
DLBCL, germinal center type
Sheet-like growth
Lymphoid cells surround glands
Marked atypia and frequent mitoses
Large lymphoid cells
CLL / SLL
CLL / SLL, CD5
CLL / SLL, CD20
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Follicular lymphoma
Follicular lymphoma, BCL2
Mantle cell lymphoma
Contributed by Mark R. Wick, M.D.
Large cell lymphoma
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Ultrasound of lymph node metastasis
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Bilateral tumors
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Intracystic papillary carcinoma
Contributed by Carlos C. Diez Freire, M.D.
Male invasive ductal carcinoma
ER
PR
Male mucinous carcinoma
Lymph node metastasis, mucinous
Male mucinous carcinoma, ER
Male mucinous carcinoma, PR
Contributed by Semir Vranić, M.D., Ph.D.
Man with adenoid cystic carcinoma
c-kit
CK14
Contributed by Julie M. Jorns, M.D. and Mark R. Wick, M.D.
Mammogram
Mammogram
Contributed by Mark R. Wick, M.D.
White mass
Contributed by Shannon M. Welter, M.D., Julie M. Jorns, M.D. and @SeoparjooAzmel on Twitter
Circumscribed tumor
Prominent lymphoid infiltrate
Syncytial growth pattern
Stromal lymphocytes
High grade nuclei
High grade nuclei
Numerous mitotic figures
Biopsy site and circumscription
Syncytial growth and lymphoplasmacytic infiltrate
Lymphoplasmacytic
infiltrate
Invasive breast carcinoma of no special type with medullary pattern
Surrounding fibrosis and inflammation
Ruptured cyst
Cluster of microcysts
Contributed by Kristen E. Muller, D.O.
Predominantly debris, cell block
Hypocellular specimen, LBP
Contributed by Julie M. Jorns, M.D.
Mammographic density: MGA / atypical MGA
Contributed by Julie M. Jorns, M.D.
Scattered round glands
Eosinophilic secretions
PAS
S100
p63
With atypia, cribriforming
With atypia, complex architecture
With atypia, S100
With atypia, collagen IV
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Breast calcifications
Contributed by Bryan E. Harmon, M.D.
Lymphocytic infiltrate
With associated DCIS
AE1 / AE3
SMMS immunostain
p63 immunostain
Contributed by Kamaljeet Singh, M.D.
Micropapillary carcinoma
Lymphovascular invasion
EMA
E-cadherin
p120
HER2 2+
HER2 3+
Mucinous micropapillary carcinoma
Mucinous hypercellular tumor
HER2+ mucinous micropapillary carcinoma
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Mixed ductal / lobular tumor
E-cadherin immunostaining of ductal components of tumor
Contributed by Kristen E. Muller, D.O. and Evan R.J. Goyette, M.D.
Luminal A
ER positive
Luminal B
HER2 positive
TNBC basal-like
TNBC basal-like
CK5
EGFR
Contributed by Carissa LaBoy, M.D.
Mammogram of right breast
Ultrasound of left breast
Mammogram of breast mass
Mammogram of left breast
Contributed by Mark R. Wick, M.D.
Pure mucinous carcinoma
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Gross mass in the breast
Contributed by Carissa LaBoy, M.D., Mark R. Wick, M.D. and AFIP images
Type A mucinous carcinoma
Type A ER positive
Type A PR positive
Type A HER2 negative
Clusters in mucin pools
Bland epithelial cell clusters
Strips of epithelium
Type B mucinous carcinoma
Neuroendocrine
features
Grimelius stain
Grimelius stain
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FNA of mucinous carcinoma
Cytology smear of mucinous carcinoma
Cytospin preparation
Colloid carcinoma
AFIP images
Cytoplasmic mucigen granules
Review of mucinous carcinoma
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Ovary - multicystic tumor
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Mucinous cystadenocarcinoma of breast with estrogen receptor expression
Retroperitoneal tumor
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Microcalcifications
Mucocele-like lesion with focal atypical proliferation
Pleomorphic calcifications
Palpable mass with tubular cystic structures
Contributed by Cansu Karakas, M.D.
Mucin filled cyst
Multiple cysts
Coarse calcifications
Extravasation of mucin
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In breast affected by burn scars
Salivary gland tumors: H&E and Alcian blue - PAS
Contributed by Julie M. Jorns, M.D. and Koteeswaran Govindaswamy, M.D. (Case #407)
Myoepithelioma with adjacent benign glands
Myoepithelioma
Myoepithelial carcinoma
Myoepithelioma - p63
Myoepithelial carcinoma - p63
Myoepithelial carcinoma - CK 5/6
Myoepithelial carcinoma - pan CK
Myoepithelial carcinoma - Ki67 IHC with high Ki67 index
Myoepithelial carcinoma - tumor cells are negative for ER, positive for PR and negative for Her2Neu
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Myoepithelioma FNA
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Summary karyogram 10 cases
Contributed by Kristen E. Muller, D.O.
Ultrasound, well circumscribed mass
Ultrasound, multilobulated mass
Mammogram
Mammogram, multiple masses
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Myofibroblastoma in gynecomastia
15 cm tumor
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13 cm, lobulated
white cut surface
Contributed by Kristen E. Muller, D.O. and Victoria Jones, M.D., M.S. (Case #536)
Well circumscribed mass
Classical type
Hypocellular, collagenized / fibrous variant
Collagenized / fibrous variant
Admixed adipocytes
Lipomatous variant
Myxoid stroma
Myxoid stroma and fat
Mast cells
Cellular variant
Epithelioid variant
Epithelioid / deciduoid variant
Epithelioid with single file growth
Smooth muscle differentiation
Chondroid metaplasia
Focal cytological atypia
Lipomatous variant
Lipomatous variant
Keratin
CD34
CD34
Desmin
ER
PR
Loss Rb1
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Loosely cohesive myoepithelial cell groups
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Pretreatment MRI
Posttreatment MRI
Contributed by Emily S. Reisenbichler, M.D.
Complete response to neoadjuvant chemotherapy
No significant response to neoadjuvant chemotherapy
Contributed by Joshua J.X. Li, M.B.Ch.B., Gary M. Tse, M.B.B.S. and Emily S. Reisenbichler, M.D.
Tumor with treatment effect
Fibrotic tumor bed
Minimal residual disease
Complete pathologic response
Posttreatment lymph node
No residual invasive or in situ tumor
Small clusters of residual invasive tumor cells
Contributed by Mark R. Wick, M.D.
Large cell carcinoma
Left lateral MRI
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Small cell carcinoma
Hyperdense mass on mammography
Hypoechoic mass on ultrasound
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Before and after chemotherapy
Contributed by Mark R. Wick, M.D.
Small cell carcinoma
Contributed by Joshua J.X. Li, M.B.Ch.B., Gary M. Tse, M.B.B.S. and Kristen E. Muller D.O.
Small cell carcinoma
Tumor cell in cords
Fine chromatin pattern
Uniform tumor cells
Cords and necrosis
Crush artifact
Abundant mitoses
Synaptophysin
Large cell carcinoma
Infiltrative tumor edge
Frequent mitotic figures
Coarse chromatin pattern
Marked nuclear pleomorphism
CD56
Chromogranin
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Crush artifact
Neuroendocrine nuclear features
Metastatic small cell carcinoma
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Mammogram
Doppler ultrasound
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Nests of tumor cells
Neuroendocrine morphology
Neuroendocrine nuclear features
Synaptophysin
Ki67
Chromogranin
CD56
AFIP images
Dense core granules
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Mammography, ultrasound and MRI of palpable left nipple mass with clear nipple discharge
Mammography, sonography and MRI images of nipple adenoma
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Nipple erythema and induration
Eroded crusted nipple adenoma
Nipple nodule with erosion
Pedunculated papillomatous nipple adenoma
Accessory breast nipple adenoma
Erosion and bloody discharge
Nipple adenoma, preoperative and postconservative excision
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Complete nipple resection
Contributed by Hal Berman, M.D., Ph.D., Miralem Mrkonjic, M.D., Ph.D. and Mary Ann Gimenez Sanders, M.D., Ph.D.
Epidermal involvement
Focal ulceration
Shave biopsy of nipple
Nipple duct involved by benign papillary proliferation
Well circumscribed epithelial proliferation
Epithelial hyperplasia and epidermal ulceration
Usual ductal hyperplasia with focal squamous metaplasia
Prominent squamous hyperplasia
Ductal carcinoma in situ
Prominent epithelial
proliferation with
papillary architecture
and tufting
Nipple section
Mixed pattern on mastectomy
Sclerosing adenosis
Papillary growth within ducts
Mixed pattern on punch biopsy
Florid usual ductal hyperplasia
Small tubules
Prominent epithelial proliferation
Dr. Jerad Gardner presents normal nipple histology and 2 cases of nipple adenoma
3 minute overview of the presentation and histology of nipple adenomas
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Breast tissue with cysts
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Increased fibroglandular density
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Cysts surrounded by fibrous tissue
Irregular fibrosis and small cysts
Fibrosis and dilated ducts
Contributed by Apeksha N. Agarwal, M.B.B.S., M.D.
Fibrocystic change
Apocrine metaplasia
Fibrosis, cysts and microcalcifications
Cysts
Contributed by Areej M. Al Nemer, M.D.
Fibrocystic change
Apocrine metaplasia
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Development of Paget disease
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Abnormal mammogram
Normal mammogram
Ultrasound
MRI
Contributed by Jennifer Tseng, M.D. and Mark R. Wick, M.D.
Nipple, crusted lesion
Nipple erosion and erythema
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Well demarcated, eczematous scaly lesion
Contributed by Alexis Synder, M.H.S. and Emily S. Reisenbichler, M.D.
Nipple ulceration
Nipple ulceration, enlarged
MPD, cut section with underlying mass
Contributed by Anna Biernacka, M.D., Ph.D. and Mary Ann Gimenez Sanders, M.D, Ph.D.
Paget disease with dermal reaction
Paget cells in basal location
Superficial extension and inflammation
Cytologic features
Spread to skin adnexa
Paget cells, shrinkage artifact
Paget cells, melanin uptake
Melanocyte hyperplasia
Full thickness with erosion
Invasive Paget disease
Mammary Paget disease CK7
Mammary Paget disease CK5/6
Mammary Paget disease HER2
Secondary Paget disease
Florid Paget disease
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Dyscohesive cell groups
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Large, pale intraepidermal Paget cells
Single Paget cell
Brief overview of Paget disease with pathologic images by Pathology mini tutorials
Contributed by Marilin Rosa, M.D.
Invasive mixed papillary and micropapillary carcinoma
No surrounding fibrous capsule
Desmoplasia
Invasive papillary carcinoma
No surrounding fibrous capsule
Invasive papillary fronds
Invasive papillary carcinoma
Papillae lack myoepithelial cells
Necrosis and calcifications
Mitotic figures
Contributed by Mark R. Wick, M.D.
Mammogram, benign
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Large tumor
Malignant tumor
Swollen breast
Contributed by Mark R. Wick, M.D.
Benign phyllodes tumor
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Large, well circumscribed tumor, benign
Malignant
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Benign phyllodes tumor
Leaf-like epithelial pattern
Low stroma to epithelium ratio
Rounded borders
Shelled out tumor
Benign stromal cells
Borderline phyllodes tumor
Phyllodal pattern
Stromal overgrowth
Distorted epithelium
Stromal mitosis
Stromal atypia
Malignant phyllodes tumor
Infiltrative borders
Marked stromal overgrowth
High stromal cellularity
Stromal atypia
Stromal giant cells
Atypical mitosis
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Benign phyllodes tumor
Biphasic pattern
Fibromyxoid stromal clumps
Benign stromal cells
Borderline phyllodes tumor
Increased stroma to epithelium ratio
Stromal cellularity
Stromal atypia
Malignant phyllodes tumor
Atypical stromal cells
Contributed by Shabnam Jaffer, M.D., Mark R. Wick, M.D.
Periareolar nodule
Mammogram
Contributed by Shabnam Jaffer, M.D.
Circumscribed tumor
Contributed by Shabnam Jaffer, M.D.
Encapsulated tumor
Biphasic benign tumor
LMWCK
SMA
Contributed by Thomas Lienhoop, M.D.
Left mammography, CC view
Left mammography, MLO view
Left breast ultrasound
Bilateral breast MRI
Left mammography, CC view
Left mammography, MLO view
Left breast ultrasound
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Circumscribed tumor
Circumscribed, gray-white mass with central necrosis
Contributed by Mirna B. Podoll, M.D., Susanne M. Crespo-Ramos, M.D. and Anna Biernacka, M.D., Ph.D.
Single file pattern
Pleomorphic nuclei
Tumor adjacent to benign glands
Desmoplastic stroma
Vacuolated cytoplasm
Classical growth, pleomorphic cells
Invasion along benign glands
Nuclear enlargement
Intracytoplasmic mucin
Cellular dyscohesion
Myoid appearance
In situ component
Solid architecture
Mixed pattern
Mosaic pattern
Fibrotic stroma
Nuclear pleomorphism
Metastatic PLC
Metastatic PLC
Histiocytoid features, dermal involvement
Histiocytoid features
Apocrine differentiation
Apocrine differentiation
Targetoid pattern
Plasmacytoid cells
Signet ring cell features
Signet ring cell features (breast type)
Signet ring cell features (gastric type)
Nested growth
Nested growth
Lymphovascular invasion
E-cadherin
Estrogen receptor
Progesterone receptor
Androgen receptor
Contributed by Susanne M. Crespo-Ramos, M.D. and Anna Biernacka, M.D., Ph.D.
Fluid cytology (Diff-Quik)
Fluid cytology (Pap)
Fine needle aspiration (Diff-Quik)
Fine needle aspiration (Pap)
Contributed by Mark R. Wick, M.D.
HER2 amplification
Contributed by Emily S. Reisenbichler, M.D.
Salivary gland equivalent polymorphous low grade adenocarcinoma
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Round mass
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Well demarcated lesion
Contributed by Indu Agarwal, M.D.
Interlobular PASH
Slit-like spaces
Spindle cells lining the spaces
PASH within areas of fibroadenoma
CD31
CD34
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Breast mammogram
Contributed by Pooja Ramakant, M.S., M.Ch.
Bilateral pubertal macromastia
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Adolescent macromastia
Virginal (juvenile) breast hypertrophy
Autoimmune related cases
Contributed by Chanchal Rana, M.D. and AFIP
Increased stromal collagenization
Increase in interlobular stroma
Juvenile / pubertal breast hypertrophy
Marked stroma collagenization
Contributed by Kristen E. Muller, D.O.
Mammogram, spiculated mass
Ultrasound, hypoechoic mass
AFIP images
Central sclerosis and elastosis resembling carcinoma
Contributed by Kristen E. Muller, D.O.
Stellate architecture
Central fibroelastotic core
Central fibroelastotic core
Squamous metaplasia
Usual ductal hyperplasia and cysts
Complex sclerosing lesion
With atypical ductal hyperplasia
With atypical lobular hyperplasia
With invasive ductal carcinoma
Tubular carcinoma for comparison
Contributed by Emily S. Reisenbichler, M.D.
Central sclerosis with fibroelastotic stroma and entrapped glands radiating outward
Contributed by
Emily S. Reisenbichler, M.D.
Radiation atypia
AFIP images
Thickened basement membranes
Atypical stromal fibroblasts
LCIS unchanged
by radiation
compared to
atrophic normal glands
Collagenization
of intralobular
stroma and glandular
atrophy
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Large stromal
fibroblasts may
also occur in
nonirradiated tissue
Atypia in normal duct
Atypia within normal lobule
Fat necrosis postiridium implant
Vessel shows
reduplicated elastic
lamina and intimal
thickening (elastin stain)
Edematous
lobules with atypia
of some epithelial
cells
Edematous
lobules with atypia
of some epithelial
cells
Atrophic lobules
with atypia of some
epithelial cells
Atypical stromal
cells, lymphocytic
infiltrate and
increased collagen bundles
Contributed by Sandra Sanchez, M.D.
Well circumscribed superficial breast mass
Oval hypoechoic mass
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Oval circumscribed mass
Superficial oval circumscribed mass
Oval circumscribed hypoechoic mass
Heterogeneously enhancing circumscribed mass
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Firm pedunculated nipple mass
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Solid mass with hemorrhage
Firm encapsulated mass
Contributed by Norman Baker, M.A., M.S., Sandra Sanchez, M.D. and Ashley Cimino-Mathews, M.D.
Nodular and variably cellular
Hypocellular and hypercellular areas
Nuclear palisading (Verocay bodies)
Gaping hyalinized blood vessels
Biopsy of breast schwannoma
Diffuse S100 positivity
Contributed by Norman Baker, M.A., M.S., Sandra Sanchez, M.D. and Ashley Cimino-Mathews, M.D.
Delicate fibrillar cytoplasm
Hypercellular cohesive tissue fragments
Nerve: schwannoma microscopy (talking slide) - Pathweb Teacher
Tip-44; breast schwannoma - Al Hussaini Virtual Lab
Schwannoma (explained in 5 minutes) Verocay bodies Antoni A & B USMLE nerve sheath tumor pathology by Dr. Gardner
Schwannoma: 5 minute pathology pearls by Dr. Gardner
Contributed by Julie M. Jorns, M.D.
Calcifications, craniocaudal view
Calcifications, mediolateral oblique view
Contributed by Julie M. Jorns, M.D.
Lobule with distortion
Calcifications and drag
Drag mark
Calponin
p63
Sclerosing adenosis with DCIS
Sclerosing adenosis with DCIS
Pathology mini tutorial
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Hypoechoic lesion on ultrasound
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Breast mass involving skin
Contributed by Gary Tozbikian, M.D. and Case #8
Glands and solid nests
Tumor cells with vacuolated cytoplasm
Low nuclear grade, no mitoses
Microcystic pattern
Extracellular secretory material
Solid pattern
PASD
S100
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Karyogram with t(12;15)(p13;q25)
FISH with disrupted ETV6 gene
Contributed by S. Emily Bachert, M.D. and AFIP
Expanded glands and terminal ducts
Luminal cells with vacuolated cytoplasm
Hobnailed luminal cells
Luminal cytoplasmic blebbing
Luminal cell nuclei
Expanded acinar glands
Abundant pale cytoplasm
Micropapillary pattern
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Sentinel lymph node biopsy
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Blue stained axillary node
Contributed by Sucheta Srivastava, M.D. and Jaya Ruth Asirvatham, M.B.B.S.
Macrometastasis
Macrometastasis with extranodal extension
Micrometastasis
Status post neoadjuvant chemotherapy
Isolated tumor cells
Isolated tumor cells, cytokeratin
Isolated tumor cells, pancytokeratin
Contributed by Sucheta Srivastava, M.D.
Touch prep
Diff-Quik
Papanicolaou
Cell block
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Rupture of silicone implant (mammography)
Snowstorm sign (ultrasound)
Extracapsular free silicone conglomerates (MRI)
Contributed by Debra L. Zynger, M.D.
Breast mass
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Fibrous capsule
Silicone lymphadenopathy
Contributed by Syed Hoda, M.B.B.S. and Julie M. Jorns, M.D.
Capsule with silicone
Silicone and synovial metaplasia
Foamy histiocytes
Clinically ruptured silicone implant
Silicone lymphadenitis
Implant with associated seroma
Silicone lymphadenitis
Contributed by Nicolas Ajkay, M.D.
Acute abscess
Single fistula
Contributed by Katie C. Hall, M.D., Anna Biernacka, M.D., Ph.D. and Mary Ann Gimenez Sanders, M.D., Ph.D.
Extension of squamous epithelium
Squamous metaplasia of lactiferous duct
Squamous metaplasia
Keratin accumulation, duct distension
Squamous and glandular lining
Duct rupture
Inflammatory response
Keratin and acute inflammation
Foreign body giant cells
Giant cells engulfing keratin
Inflammation, giant cells, keratin
Keratin, slit-like spaces
Periductal inflammation
Metaplastic squamous epithelium
Plasma cell rich infiltrate
Surface epithelium
Involved duct
Keratin debris
Lactiferous ducts of the nipple
Deep in nipple
Normal transition
Normal transition, CK7
Normal transition, p63
Contributed by Mary Ann Gimenez Sanders, M.D., Ph.D.
Pap smear
Contributed by Melinda Lerwill, M.D.
Invasive solid papillary carcinoma
Contributed by Melinda Lerwill, M.D.
Invasive solid papillary carcinoma
Contributed by Melinda Lerwill, M.D.
Multiple nodules
Solid growth
Cytologic atypia
Spindle cells
Mucin
Invasive pattern
Jigsaw-like pattern
Irregular invasive nests
Ragged contours
Solid papillary carcinoma with mucinous carcinoma
Chromogranin
Cytokeratin 14
p63
Contributed by Melinda Lerwill, M.D.
Granular chromatin
Capillary vessel
Papillary lesions of the breast
(Dr. Collins)
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Life cycle of Spirometra
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Mammography with nodular and tortuous structure
Ultrasound with nodular tubular hypoechoic lesion
Mammography with tubular elongated structure
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Scolex of the sparganum
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White, ribbon-like sparganum
Contributed by Bobbi Pritt, M.D.
Sparganum in breast tissue
Spargana
Longitudinal smooth muscle fibers
Calcareous corpuscles
Contributed by Emily S. Reisenbichler, M.D.
Poorly differentiated breast carcinoma, metastatic to the liver (H&E and GATA3 immunostain)
Case #125
Breast cancer metastases - to endometrial polyp
Breast cancer metastases - to endometrial polyp
(left to right): ER, PR, GCDFP-15
Breast cancer metastases - to cervix
AFIP images
Partially cystic tumor
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Presenting as a cystic mass
Cystic area with
necrosis (upper);
gray-white solid
area (below)
Contributed by Chanchal Rana, M.D.
Cystic lesion with infiltration
Desmoplastic stromal reaction
Keratin pearls
High Ki67 proliferation index
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Polygonal tumor cells with abundant eosinophilic cytoplasm and nuclear hyperchromasia
Contributed by Debra L. Zynger, M.D.
Bone metastasis (pM1)
Contributed by Sucheta Srivastava, M.D.
Macrometastasis
Macrometastasis with extranodal extension
Micrometastasis
Isolated tumor cells, pancytokeratin
AFIP images
Papillary duct proliferation
Solid foci in ducts
Papillary duct hyperplasia
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Extramammary tissue may arise anywhere along mammary ridge
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Proliferation of glandular tissue, without areola or nipple
Normal appearance of accessory breast tissue on mammography
Accessory breast tissue on ultrasound
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Supernumerary nipple in a neonate
Supernumerary nipple in an adolescent boy
Supernumerary nipple (bilateral) in an adolescent girl
Ectopic supernumerary nipple on the shoulder
Nipple on foot
Large axillary supernumerary breast
Hyperpigmented papule shape skin elevation
Cutaneous fibroadenoma in ectopic breast tissue
Supernumerary nipple on abdomen
Contributed by Sara Salehiazar, M.D. and Gary Tozbikian, M.D.
Normal appearing mammary glands
Mammary type glands in the deep dermis
Glands in the deep dermis
Mammary glands in the dermis
Extra nipple under the microscope
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Firm subareolar mass, 17 mm in diameter
Contributed by Dr. Mark R. Wick:
Syringomatous tumor
Contributed by Emily S. Reisenbichler, M.D.
Syringomatous tumor of nipple
AFIP images
Keratinization in syringomatous duct
Contributed by Dr. Mark R. Wick
Syringomatous tumor
Perineurial invasion
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Acanthotic epidermis
Small, solitary, evenly spaced duct-like structures
Layers of cuboidal or squamoid epithelial cells
Small, dark tumor cells
Keratotic cysts
Contributed by Koorosh Haghayeghi M.D., Sonja Chen M.D. and Yihong Wang M.D.
Solid epithelial nodules
Solid papillae
Papillae with histiocytes
Reverse polarity
Papillae with reverse polarity
Petite papillae
CK5/6
p63
SMMHC
E-cadherin
MUC1
ER
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Pre and postoperative photographs
Contributed by Kelsey McGinley PA (ASCP) and Gabrielle M. Baker, M.D.
Mastectomy
specimen
Contributed by Yaileen Guzman, M.D. and Gabrielle M. Baker, M.D.
Ductal carcinoma in situ
Atypical ductal hyperplasia
Toker cells
Toker cell hyperplasia
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Enhancement on MRI
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
High grade ductal carcinoma
Low grade adenosquamous carcinoma
Squamous cell carcinoma
Carcinoma with medullary features
Triple negative immunophenotype
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Abundant lymphocytes
Ill defined cell borders
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Ulcer on the breast
Contributed by Reena Tomar, M.B.B.S., M.D.
Benign breast ductules and lymphohistiocytic infiltrate
Epithelioid cell granuloma
Epithelioid cell granuloma and Langhans giant cells
Epithelioid cell granuloma with lymphocytes
Caseous necrosis
Benign breast ductules and caseous necrosis
Ziehl-Neelsen stain
Contributed by Reena Tomar, M.B.B.S., M.D.
Epithelioid cell granulomas with lymphocytes
Epithelioid cell granulomas
Contributed by Julie M. Jorns, M.D.
Diagnostic mammogram
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Yellow-white sclerotic mass
Contributed by Julie M. Jorns, M.D., Mark R. Wick, M.D. and AFIP
Infiltrative angulated tubules
Angulated tubules
Apical tufting
Desmoplasia
Associated ADH, FEA and ALH
Associated atypical lobular hyperplasia
Associated atypical ductal hyperplasia / flat epithelial atypia
Apical tufting
Open tubules
Angular glands with cytoplasmic snouts
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Ultrasound
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Lesion in accessory breast
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Well defined borders
Tan cut surface
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Well defined borders
Closely packed tubules
CK5/6
p63
Eosinophilic luminal secretions
Sparse intervening stroma
Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Well defined lesion
Mimicking invasion
Myoepithelial layer on CD10
Breast tubular adenoma immunoprofile
Contributed by Joshua J.X. Li, M.B.Ch.B. and Gary M. Tse, M.B.B.S.
Background naked nuclei
3 dimensional cell balls
Bland nuclear features
Contributed by S. Emily Bachert, M.D. and AFIP