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Chest radiograph
Acute fibrinous organizing pneumonia in left upper lobe
Multifocal opacities
Before and after corticosteroid therapy
Before disease onset and before / after corticoid therapy
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Low power
Medium power
High power
Elastica van Gieson staining
Fibrin balls
Fibrin balls
Acute fibrinous and organizing pneumonia
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Fibrin balls in air spaces
Fibrin balls in air spaces
AFOP
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Chest radiograph
Exudative phase on CT
Organizing phase on CT
Comparison on CT and histology
Contributed by Yale Rosen, M.D.
Gross images of diffuse alveolar damage
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Low power
Architectural destruction
Fibroblastic proliferation
Type II pneumocyte hyperplasia
Lymphocytic infiltration
Epithelial denudation
Dense fibrosis with smooth muscle hyperplasia
Organizing phase - proliferation of fibroblasts and type II pneumocytes
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Organizing phase
Organizing phase - fibroblastic proliferation
Exudative phase and organizing phase
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Atypical epithelial cells in BAL fluid
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Lung immune system
Specimen handling
Organisms causing CAP
Hospitalization rate
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Lobar pneumonia
Bronchopneumonia
Bronchopneumonia
Tree in bud opacity
Necrosis and cavitation
Pneumonia, hematogenous spread
Aspiration pneumonia
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Lobar pneumonia
Bronchopneumonia
Bronchopneumonia
Bronchopneumonia
Streptococcus pneumoniae
Staphylococcus aureus
Streptococcus pyogenes
Klebsiella pneumoniae
Pseudomonas aeruginosa
Contributed by Sakda Sathirareuangchai, M.D., Yuri Tachibana, M.D. and @AminiaCiobanoiu on Twitter
Intra-alveolar neutrophils
Acute bronchiolitis
Bacterial colonies
Diffuse alveolar damage
Granulomatous inflammation
Foreign body
Foreign body
Necrotizing inflammation
Alveolar exudate
Acute pneumonia
Acute pneumonia
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S. pneumoniae (sputum, Gram stain)
P. aeruginosa (sputum, Gram stain)
BAL, purulent exudate
FNA, purulent exudate
FNA, gram negative bacilli
Bronchopneumonia
Lobar pneumonia
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AIS as ground glass lesion
Contributed by Atreyee Basu, M.D. and Fang Zhou, M.D.
Firm, tan, ill defined lesion
Contributed by Atreyee Basu, M.D. and Fang Zhou, M.D.
Neoplastic cells, lepidic pattern
Neoplastic cells, nuclear atypia
Contributed by Atreyee Basu, M.D. and Fang Zhou, M.D.
Nuclear irregularities and anisocytosis
Nuclear pseudoinclusions and grooves
Nuclear atypia
TTF1 immunostain
Adenocarcinoma in situ
by Dr. Thomas Colby
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Histologic subtyping for surgeon
Histologic pattern and prognosis
Treatment
Grading of invasive nonmucinous adenocarcinomas
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Mucinous adenocarcinoma
Adenocarcinoma on axial CT
Contributed by Yale Rosen, M.D.
Peripheral adenocarcinoma
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Peripheral adenocarcinoma
Contributed by Caroline I.M. Underwood, M.D., Andrey Bychkov, M.D., Ph.D., Fulvio Lonardo, M.D. and Negar Rassaei, M.D.
Adenocarcinoma in situ
Acinar pattern
Lepidic pattern, architecture
Lepidic pattern, cytologic features
Micropapillary pattern
Papillary pattern
Papillary pattern
Solid pattern, architecture
Solid pattern, cytologic features
Mucinous subtype, architecture
Mucinous subtype, cytologic features
Positive PDL1
Negative PDL1
ADC cocktail
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Large malignant cells
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Adenoid cystic carcinoma
obstructing right upper
lobar bronchus
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Various images
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75 year old woman with 1 cm lung lesion
Contributed by Yale Rosen, M.D. and @ThatGlassTho on Twitter
Adenoid cystic carcinoma
Adenoid cystic carcinoma
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Cribriform-like structures with mucus
Focal tubular structure
Various images
14 year old girl with 11 cm lung mass
75 year old woman with 1 cm lung lesion (H&E, TTF1)
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Cytomorphology of pulmonary adenoid cystic carcinoma
Contributed by Maharshi Panchal, M.D.
Bronchial adenoma on CT
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Chest Xray and CT scan of BA / CMPT
FDG PET CT of BA / CMPT
CT scan of CMPT
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20 mm mucinous
nodule in right
lower lobe
Papillary adenoma connected to the pleura
10 mm, ill defined
gray-white CMPT
Contributed by Saltanat Ualiyeva, M.D. and Atreyee Basu, M.D.
Neoplasm with mucin and epithelium
Neoplasm with mucin and bilayered epithelium
Subpleural neoplasm with mucin
Mucinous neoplasm with bilayered epithelium
p63 immunostain
CK5/6 immunostain
TTF1 immunostain
Contributed by Roseann Wu, M.D., M.P.H. and Yale Rosen, M.D.
Adenosquamous carcinoma
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Transbronchial lung biopsy with adenocarcinoma and squamous cell carcinoma
Adenocarcinoma forming mucous membranes and parts of the squamous epithelial carcinoma
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Adenosquamous carcinoma
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With KRAS and EGFR mutations
Contributed by Roseann Wu, M.D., M.P.H.
Glandular and squamous features
Adenosquamous carcinoma
Glandular squamous carcinoma morphology
Contributed by Roseann Wu, M.D., M.P.H.
Glandular and squamous features
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Adenosquamous carcinoma
Metastatic adenosquamous carcinoma of the lung to wrist with squamous histology
Contributed by Elliot Weisenberg, M.D.
Adenovirus inclusions
in lung from an infant
chimpanzee
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Interstitial inflammation (no inclusions identifiable)
Various images
Contributed by Tan-Lucien H. Mohammed, M.D.
Tracheobronchial amyloidosis
Airway thickening
Ground glass consolidation
Pulmonary nodular amyloidosis
Basilar gradient
Scattered nodules
Multiple nodules and cysts
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Primary endobronchial amyloidosis
Contributed by Brian D. Stewart, M.D.
Nodular deposits
Vascular deposition
Congo red
Congo red, polarized
Contributed by Andras Khoor, M.D., Ph.D.
Ossification
Diffuse septal deposition
Periarteriolar accentuation
Tracheobronchial deposition
Subepithelial deposits
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Beta pleated sheet
Amyloid fibrils
Definition, historical aspects and properties
Pathogenesis and classification
Pathology, clinical features and prognosis
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Various images
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Various images
Lung, glandular stage
Lung, glandular stage; top: spine
Top: spine; lower left: trachea and esophagus; center: lung, glandular stage
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Acute phase
Organizing phase
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Changes in ARDS
Exudative phase
Exudative phase
Exudative phase
Proliferative / organizing phase
Fibrotic phase
ARDS on CT
ARDS on CT
ARDS on CT
Contributed by Yale Rosen, M.D.
Diffuse alveolar damage (DAD)
Patchy lung involvement
Diffuse alveolar damage (DAD)
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Hyaline membrane
Hyaline membrane
Hyaline membrane
Hyaline membranes and fibrin
Masson body
Masson body
Masson body
Organizing DAD
Collagenous fibrosis
Fibroblastic proliferation
Fibroblastic proliferation
Interstitial organization
Inflammatory cells
Histology of DAD
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Pleural plaque
Contributed by Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Asbestos bodies in alveolar spaces
Ferruginous body
Asbestos body
Dumbbell shaped asbestos body
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Aspergillus life cycle
Syndromes associated with aspergillosis
Spectrum of aspergillosis
Mechanism
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ABPA, chest Xray and CT
CCPA, chest CT
CCPA, air crescent sign
IPA, chest Xray
IPA, chest CT
IPA, halo sign
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Abscess
Aspergilloma
Invasive aspergillosis
Systemic invasive aspergillosis
Contributed by Sakda Sathirareuangchai, M.D., Venna Maheshwar, M.D., Kiran Alam, M.D., Anshu Jain and Claudia Mendez, M.D.
Chronic cavitary pulmonary aspergillosis
Allergic bronchopulmonary aspergillosis
Invasive pulmonary aspergillosis
Invasive pulmonary aspergillosis
Aspergilloma, PAS stain
GMS stain
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Lung FNA, granuloma
Lung FNA, Aspergillus
BAL cytology, Aspergillus
Bronchial washing, Aspergillus
Sputum, calcium oxalate crystal
Bronchial brushing, Aspergillus
Lung TBNA, Aspergillus
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Scanning EM, A. fumigatus
Pulmonary aspergillosis
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Mucus plugs
Status asthmaticus
Contributed by Bobbi Pritt, M.D., Neil Harris, M.D. and Stacy Beal, M.D.
Curschmann spirals
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Smooth muscle hypertrophy and inflammatory cells
Eosinophils and Charcot-Leyden crystals
Curschmann spirals
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Conventional TSCT
Contributed by Sherman Lin and Matthew J. Cecchini, M.D., Ph.D.
Small proliferation
of larger
hyperchromatic
cells
Proliferation of atypical pneumocytes
Discontinuous monolayer of atypical cells
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Bronchial occlusion
Endobronchial tumor
Tumor near trachea
Contributed by Philippe Joubert, M.D., Ph.D.
Peripheral carcinoid
Histologic pattern: rosettes
Histologic pattern: organoid
Histologic pattern: papillary
Histologic pattern: solid
Cytologic features: salt and pepper chromatin
Cytologic features: spindle cell features
Cytologic features: eosinophilic cytoplasm
Increased mitotic rate
Necrosis (larger focus)
Necrosis (punctate)
Lymphovascular invasion with punctate necrosis
Stroma: ossification
AE1 / AE3
CD56
Chromogranin
TTF1
Ki67
Elevated proliferation rate
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CT of benign metastasizing leiomyoma in lung
Contributed by Roseann Wu, M.D., M.P.H.
Homogenous whorled cut surface
Contributed by Roseann Wu, M.D., M.P.H.
Well circumscribed lesion
Bland spindle cells
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FNA, large clusters of spindle shaped cells
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PCR amplification of lung and uterine tumors
Telomere length by FISH
Benign metastasizing leiomyoma
Contributed by Phillip McMullen, M.D., Ph.D.
Lung mass
TTF1
p40
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Morphological types
Different etiologies of bronchiectasis
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CT, coronal cross section
CT, axial cross section
Contributed by Kristine Konopka, M.D.
Dilated airways with mucoid deposition
Dilated airways
Contributed by Heather I-Hsuan Chen-Yost, M.D.
Lung explanted for cystic fibrosis
Diffuse inflammation and mucus plugging
Mixed acute and chronic inflammation
Lung explanted for idiopathic pulmonary fibrosis
Features of organizing pneumonia
Histopathology: lung bronchiectasis
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Severe fibrosis
Large alveoli
Contributed by Andréanne Gagné, M.D., M.Sc. and Philippe Joubert, M.D., Ph.D.
CT scan: nodules
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Peribronchiolar nodules
Multiple nodules
Nodules and air trapping (DIPNECH)
Contributed by Andréanne Gagné, M.D., M.Sc. and Philippe Joubert, M.D., Ph.D.
Peripheral nodule
Poorly delineated nodule
Tumorlet
Tumorlet arising in DIPNECH
Small tumorlet
Clear cell features
Spindle cell features
Salt and pepper chromatin
CD56
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CT before / after targeted therapy
Large mass on CT scan
Mass lesion located left hilar localization
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Bronchial carcinosarcoma
Contributed by Yale Rosen, M.D. and Jian-Hua Qiao, M.D.
Giant cell carcinoma
Core biopsy
AE1 / AE3
CAM 5.2
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Various images
Initially presenting as invasive aspergillosis
Blastomatoid variant
Lung parenchyma showing infiltration
Lipoblastic elements with spindle cell component
Adenocarcinoma with acinar growth pattern
Malignant poorly formed epithelial glands
S100
CK7 and TTF1
Carcinoma with atypical glands
H&E
Contributed by Jian-Hua Qiao, M.D.
Highly pleomorphic giant cells
Highly pleomorphic giant cells
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Mucosal glandular hyperplasia
Chronic inflammatory infiltrate
Contributed by Dr. Michael P. Orejudos and Dr. Rosemarie Rodriguez
Contributed by @Andrew_Fltv on Twitter
Coal workers' pneumoconiosis
Coal workers' pneumoconiosis
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Coal workers' pneumoconiosis
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Endemic areas
Coccidioides spp. life cycle
Contributed by Sakda Sathirareuangchai, M.D.
Spherules
Spherule
Spherules GMS
Contributed by Sakda Sathirareuangchai, M.D.
Spherule cytologic smear
Dimorphic fungi: coccidioidomycosis by Glenn D. Roberts, Ph.D.
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Radiological evaluation
Radiology and bronchoscopy
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Intraoperative view
of white mass
with indistinct
margins
Intraoperative
view of giant
cystic colloid
adenocarcinoma
Contributed by Matthew J. Cecchini, M.D., Ph.D.
Gross cut surface
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Gross cut surface
Cystic lesion with mucin pooling
Contributed by Gheorghe-Emilian Olteanu, M.D., Ph.D., Ana Mataić, M.D. and Luka Brčić, M.D., Ph.D.
Abundant extracellular mucin
Mucin laden cells
Hypercellularity
Inflammatory infiltrate
Nuclear and cytoplasm detail
Siderophages and colloid adenocarcinoma cells
Extensive extracellular mucin
CK20 IHC stain
CDX2 IHC stain
CK7 IHC stain
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Clusters of cells with basally oriented nuclei
Contributed by Nya D. Nelson, M.D., Ph.D. and Jennifer Pogoriler, M.D., Ph.D.
Type 1 CPAM
Type 2 CPAM
Type 3 CPAM
Contributed by Nya D. Nelson, M.D., Ph.D. and Jennifer Pogoriler, M.D., Ph.D.
Type 1 CPAM
Type 1 CPAM complexity
Mucinous cell clusters
Small mucinous cell cluster
Type 2 CPAM
Type 2 CPAM - mucostasis
Congenital lobar emphysema
Type 3 CPAM
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SARS-CoV-2
Pathogenesis of COVID-19
Epidemic timeline of COVID-19
Timeline of tissue changes
Timeline of autopsy studies
Autopsy PPE
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Chest CT images
Severe changes
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Grossing protocol
Thickened alveolar septa, thromboemboli
Patchy consolidations
Subsegmental pulmonary embolism
Contributed by Toru Igari, M.D., Jin Takahashi, M.D. and Shinyu Izumi, M.D.
Bronchial change
Squamous metaplasia
Acute phase
Hyaline membranes
Organizing phase
Organizing phase
Organizing phase
Fibroblastic proliferation
Lymphocytic infiltration
Pneumocyte hyperplasia
Epithelial denudation
Epithelial denudation
Perivascular lymphocytes
Clear cell change
Multinucleation
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Lung injury patterns
SARS-CoV-2 in lung
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Inflammatory background
Nuclear, cytoplasmic inclusion
Multinucleated alveolar macrophage
Multinucleated giant cell
BAL ThinPrep
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Scanning electron microscopy
Transmission electron microscopy
Virus in epithelial cells
Pathology of COVID-19: a pulmonary pathologist explains
Sample management
Autopsy
SARS-CoV-2 detection in tissues
Pulmonary pathology
Cardiovascular pathology
COVID-19 autopsy pathology findings
Histology of acute respiratory distress syndrome
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CFTR
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High resolution CT
Contributed by Akira Yoshikawa, M.D.
Low power
Middle power
Smoker's macrophages
Giant cells
Lymphoid follicles
Low power
Middle power
Smoker's macrophages and interstitial fibrosis
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Trichrome staining
H&E and IHC of CD68
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Numerous lysosomes in macrophages
Histopathology Lung - Desquamative interstitial pneumonia
Contributed by Andréanne Gagné, M.D., M.Sc. and Philippe Joubert, M.D., Ph.D.
CT scan:
mosaic perfusion
CT scan: nodules
Contributed by Andréanne Gagné, M.D., M.Sc. and Philippe Joubert, M.D., Ph.D.
Small nodules
Linear proliferation
Nodule occluding a bronchiole
Discrete proliferation
Tumorlet
Tumorlet
Salt and pepper chromatin
Chromogranin
Synaptophysin
CD56
- Xray: nonspecific findings, including pleural effusion, diffuse pulmonary opacities, interstitial thickening
- CT: bilateral ground glass opacities, smooth thickening of interlobular septa, bronchovascular bundles, pleura; may show infiltration of the mediastinal soft tissue by cystic fluid densities
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Lower lung heterogeneous opacities
Thickening with effusions
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Subpleural lymphatic vessels
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D2-40
Native lung
Multiple proliferating vascular spaces
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Components of COPD
Classification of emphysema
High resolution CT diagram
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Centriacinar emphysema
Centriacinar emphysema
Panacinar emphysema
Paraseptal (distal acinar) emphysema
Interstitial emphysema
CPFE
AATD
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Centriacinar emphysema
Centriacinar emphysema
Panacinar emphysema
Paraseptal (distal acinar) emphysema
Centriacinar versus panacinar emphysema
Cystic formation from alveolar wall destruction
Lung bullae
"Dirty holes" in subtle emphysema
Combined emphysema and fibrosis
Contributed by Akira Yoshikawa, M.D.
Normal lung architecture
Peribronchiolar region
Centriacinar involvement
Panacinar emphysema
Paraseptal emphysema
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Remodeling of elastin and collagen
Emphysema histology
Emphysema classification
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Right upper lobe
and mediastinal
lymph node
metastasis
Tumor in the lower lobe of the left lung
Contributed by Sevilay Özmen, M.D. and Pembe Oltulu, M.D.
Moderately differentiated glands with necrotic debris
Cribriform and acinar growth pattern
Glands filled with necrotic debris
Cribriform growth pattern
Glands filled with necrotic debris
CK7 positivity
CK20 positivity
CDX2 positivity
TTF1 positivity
Contributed by Sevilay Özmen, M.D.
Small clumps of tumor cells
Cluster of tumor cells
Papillary cluster
Acinar cluster
Case #105
Acute eosinophilic pneumonia
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Chest Xray and
CT of peripheral nodule
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Bronchoscopy with lobulated
endobronchial mass
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Incidental endobronchial mass
Peripheral tumor
Contributed by Roseann Wu, M.D., M.P.H. and Case #357
Epithelial myoepithelial carcinoma arising from airway
Lung biopsy
Lung biopsy
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Tumor with tubular and
glandular structures
Incidental endobronchial mass - H&E
Incidental endobronchial mass - calponin
Incidental endobronchial mass - S100
Incidental endobronchial mass - AE1 / AE3
Incidental endobronchial mass - CK7
Incidental endobronchial mass - CK903
Incidental endobronchial mass - Ki67
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Well differentiated tumor
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Various images
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Multiple nodules and ground glass opacities
Large bilateral pulmonary cavities
Contributed by Yale Rosen, M.D. and Philip Kane, M.D.
Nodules with central cavitation
Solid nodule
Solid nodule with areas of cavitation
Contributed by Matthew J. Cecchini, M.D., Ph.D.
Blue (dirty) necrosis
Geographic necrosis
Blue (dirty) necrosis in core needle biopsy
Granulomatous inflammation
Vasculitis
Focal vasculitis
Small vessel vasculitis
Hyperchromatic giant cells
Capillaritis
Granulomatosis with polyangiitis (pathophysiology, symptoms, treatment)
GPA symptoms, diagnosis, treatment
GPA review
GPA discussion at 5:01
Contributed by Yale Rosen, M.D.
Various images
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Immunostain highlights
HSV+ cell in
broncheo-alveolar lavage
Contributed by Hirotsugu Hashimoto, M.D., Ph.D.
Cut surface of the lung
Contributed by Hirotsugu Hashimoto, M.D., Ph.D.
Bronchovascular bundle
Bronchial wall
Miller's secondary lung lobule
Miller's secondary lung lobule (elastica Masson)
Peripheral airway (bronchiole to alveoli)
Alveoli
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Type II alveolar epithelium (pneumocyte)
Contributed by Jamie Shutter, M.D.
H&E
GMS
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GMS staining
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CMV and pulmonary alveolar proteinosis
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Lobulated mass in right lower lobe of lung
Solitary, noncalcified nodule in left lower lobe
Preoperative CT of pulmonary HCCC
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Intrabronchial protrusion of mass
Bronchoscopy of pulmonary HCCC and SCC
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Well demarcated,
creamy white
intrabronchial
mass
Solid, white and well demarcated lung mass
Contributed by Aliya N. Husain, M.D.
Nest, trabeculae and glandular pattern
Monomorphic tumor cells
Hyalinized stroma
Inconspicuous nucleoli
Clear to eosinophilic cytoplasm
Stroma is densely hyalinized
p40 nuclear positivity
Cytoplasmic positivity with AE1 / AE3 immunostain
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Detection of EWSR1::ATF1
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Chest X-ray and CT image of HP
CT of HP
CT of acute HP due to isocyanate
CT of subacute HP of a farmer
CT of chronic HP of a plastic industrial worker
CT of HP due to nontuberculous mycobacterium
Scroll to see all images:
Case 1: 69 year old woman with history of exposure to bird antigen
Case 2: 67 year old man with history of exposure to garden chemicals
Case 2: 67 year old man with history of exposure to garden chemicals
Case 3: 72 year old male woodcutter
Case 3: 72 year old male woodcutter
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Airway centered lymphocytic infiltration with granuloma
Airway centered lymphocytic infiltration with fibrosis
Poorly formed granulomas
Poorly formed granulomas
Peribronchiolar metaplasia
Intra-alveolar fibrindeposition
Giant cells
Comparison of
granulomatous lesions
of different diseases
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Bronchoalveolar lavage fluid
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Severe pulmonary hypoplasia
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Various images
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Pathophysiology of hemodynamic instability
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Saddle PE on CTA
Contributed by Aliya N. Husain, M.D. and @yro854 on Twitter
Pulmonary thromboembolism
Infarct / pulmonary emboli
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Thromboemboli in pulmonary artery
Saddle embolus
Hemorrhagic infarct
Organizing infarct
Fibrous band
Contributed by Aliya N. Husain, M.D. and @msnsayed14 on Twitter
Lines of Zahn
Postmortem clot
Organizing thrombus
Organized thromboembolism
Recanalized
thromboembolism
Organized thrombus
Bone marrow embolism
Infarct / pulmonary emboli
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Bronchoscopy with biopsy
Contributed by Roseann Wu, M.D., M.P.H.
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Myofibroblasts with plump oval nuclei
Lymphoid hyperplasia and lymphocytic infiltration
Nodular lesions and infiltrating lymphocytes
Variable appearance of ALK rearranged IMTs
Contributed by Dr. K.V. Vinu Balraam
Lung
Pulmonary lymph node
Kidney
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NSIP pattern on CT
OP pattern on CT
LIP pattern on CT
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Clinical features in systemic sclerosis
Digital ulceration
Telangiectasia
Raynaud's phenomenon
Raynaud's phenomenon
and telangiectasia
Clinical features in dermatomyositis
Mechanic hand
Gottron's sign
Contributed by Akira Yoshikawa, M.D.
Low power
NSIP pattern
Lymphoplasmacytic infiltration without lymphoid follicles
Pleural thickening and pleuritis
Vascular wall thickening
Emphysematous change
Low power
UIP pattern
Lymphoid follicles with germinal centers
Honeycomb change
Honeycomb change
Lymphoplasmacytic infiltration
Dense fibrosis with lymphocytic infiltration
Also see: NSIP
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NSIP pattern
OP pattern
OP pattern
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LIP pattern
Contributed by Sergio Pina-Oviedo, M.D.
Multifocal intravascular infiltrates
Intravascular lymphoid infiltrate
Intravascular lymphoma cells
Alveolar septal thickening
CD3 / CD20 double immunostain
CD3 / CD20 double immunostain
CD79a
CD3
CD31
Pancytokeratin
Ki67
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Polarized light
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Survival curves
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Computed tomography
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Invasive mucinous adenocarcinoma
Invasive, diffuse
Lepidic growth pattern
Contributed by Akira Yoshikawa, M.D.
Intraalveolar mucin
Nodules with fibrosis
Tumor periphery
Diffuse spread
Acinar growth pattern
Admixed pneumocytes
Abundant apical mucin
Extracellular and apical mucin
HNF4α
TTF1 / Napsin A
Contributed by @zaalruwai83 on Twitter
Invasive mucinous adenocarcinoma
Contributed by Takashi Hori, C.T. and Akira Yoshikawa, M.D.
Cluster of tumor cells
Gold mucin
Papillary cluster
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Tiny nodules
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Microcystic change
End stage Langerhans
Kidney bean shaped nuclei
CD1a+
CD1a, CD56, S100
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Birbeck granules
Binucleated Langerhans cells, orbit
Contributed by Debra L. Zynger, M.D.
Right lung mass
Contributed by Emily O. Symes, M.D.
Sheets of tumor cells
Necrosis and lymphovascular invasion
Extensive necrosis
Lymphovascular invasion
Spread through air spaces (STAS)
High power tumor cells
TTF1
CK5/6
p40
Napsin A
PDL1
Mucin stain
Contributed by Roseann Wu, M.D., M.P.H.
Peripheral LCNEC
Contributed by Ioanna Abba Nteka, M.D., Aggeliki Cheva, M.D., Ph.D., Antonia Loukousia, M.D., Roseann Wu, M.D., M.P.H. and Kyriakos Chatzopoulos, M.D., Ph.D.
Nesting, peripheral palisading, necrosis
Nuclear pleomorphism, prominent nucleoli, mitosis
Solid and nested architecture
Vascular invasion
Cytokeratin
CD56
Synaptophysin
Chromogranin
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Nuclear pleomorphism with prominent nucleoli (Pap)
Peripheral palisading
(Diff-Quik)
Rosette-like structure
(Diff-Quik)
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Ground glass opacity
Contributed by Jonathan Keow, M.D., Ph.D. and Matthew J. Cecchini, M.D., Ph.D.
Lepidic growth pattern
With uninvolved lung parenchyma
Lepidic adenocarcinoma with focal invasion
Noninvasive lepidic adenocarcinoma
Lepidic adenocarcinoma
Lepidic adenocarcinoma in a background of emphysema
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Yellow cut surface
Case #287
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Aspiration pneumonia
Foamy macrophages in alveolar spaces
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Endoscopy
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Complete encapsulation
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Atypical lipoma
Mature adipose tissue
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Computed tomography
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Multiple cysts
Contributed by Roseann I. Wu, M.D., M.P.H. and Yale Rosen, M.D.
Cystic lung with nodule
Multiple cysts
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Outer flattened cells
SMA, HMB45, D2-40
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Type II pneumocytes in LAM nodule
Virtual slide review of a case of lymphangioleiomyomatosis
Overview of radiographic features of lymphangioleiomyomatosis
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Xray and CT scans
Unenhanced thoracic CT
Contributed by Heather I-Hsuan Chen-Yost, M.D.
Lymphoid-like lesion
Lymphoid infiltrate and syncytial cells
EBER ISH stain
p63 immunostain
CK5/6 immunostain
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Various images
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Excised mass
Contributed by Roseann Wu, M.D., M.P.H.
Syncytial growth of monomorphous, polygonal epithelial cells
EBER+
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Various images
Various images
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Ground glass opacity with cyst formation and nodules
Contributed by Akira Yoshikawa M.D. and Yale Rosen, M.D.
Low power
Bronchovascular bundle
Architectural destruction
Septal thickening
Massive lymphocytic infiltration
Giant cells and lymphocytes
Lymphocytes and histiocytes
Granuloma and lymphocytes
Lymphoid aggregate and histiocytes
Diffuse cellular pattern
Lymphoplasmacytic infiltration
Lymphoplasmacytic infiltration
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LIP
Numerous lymphoid follicles
EBV related LIP
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Grayish white, ill
defined lesion with
central cavitation
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Various images
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Giant cells
Histopathology Lung - Measles pneumonia
Contributed by Fulvio Lonardo, M.D.
Pancreas: adenocarcinoma
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Malignant melanoma
shows pulmonary
nodules
Multiple round nodules and masses in both lungs
Cannonball lung metastases in patient with colon cancer
Multiple lung metastases
Contributed by Roseann Wu, M.D., M.P.H.
Lung with metastatic tumor
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Multiple tumor nodules
Contributed by Roseann Wu, M.D., M.P.H., Debra Zynger, M.D., Case #318 and Fulvio Lonardo, M.D.
Metastatic colon CA to lung 25x
Clear cell renal
cell carcinoma
metastatic to lung
Prostatic
adenocarcinoma
metastatic to lung
Testicular germ
cell tumor (teratoma)
metastatic to lung
Jaw: ameloblastoma
metastatic to lung
Pancreas: adenocarcinoma
Contributed by Roseann Wu, M.D., M.P.H.
Metastatic renal cell carcinoma to lung
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Bladder, urothelial carcinoma
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Figure A: Macroscopic examination
showing white tinged lesions
Contributed by Roseann Wu, M.D., M.P.H.
Micronodular pneumocyte hyperplasia
TTF1 stain
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Morphology of pulmonary lesions
Multifocal micronodular pneumocyte hyperplasia
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Ground glass lesion on CT scan
Contributed by Sarah Aziz, M.D.
Lobectomy specimen
Contributed by Jonathan Keow, M.D., Ph.D.
Noninvasive and invasive components
Noninvasive lepidic adenocarcinoma
Focus of invasive adenocarcinoma
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CT scan with
1 cm nodule
Positron emission tomography
Chest film shows bilateral diffuse nodules
CT scan shows nodules
Contributed by Jian-Hua Qiao, M.D.
Interstitial nests of spindle cells
CD56
EMA
PR
Vimentin
AE1 / AE3
CK5 / 6
Contributed by Jian-Hua Qiao, M.D.
Papanicolaou (Pap) stain
p63
p40
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Interdigitating cells and desmosomes
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Heterogeneously enhancing lesion
Mass shadow measuring 30 mm
Mass in right upper lobe and left hilum
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Well circumscribed endobronchial tumor
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Mucoepidermoid carcinoma of airways
Tumor in middle lobe bronchus
Contributed by Roseann Wu, M.D., M.P.H. and Yale Rosen, M.D.
Low grade mucoepidermoid carcinoma
Low grade MEC mucicarmine stain
High grade mucoepidermoid carcinoma
Mucoepidermoid carcinoma, low grade
Stroma infiltrated by inflammatory cells
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MEC of lung
EGFR seen in squamous and intermediate cells
Pulmonary MEC
MEC-like pulmonary carcinoma
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MAML2 rearrangement by FISH
Gliding phase
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Abscess
Contributed by Yale Rosen, M.D.
Small abscess
Gram stain
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Modified acid fast stain
shows weakly acid fast
branching, filamentous bacilli
Contributed by Dr. Sajna V.M. Kutty, MVR Cancer Centre and Research Institute, Kozhikode, Kerala, India
Rib tumor
Contributed by Dr. Sajna V.M. Kutty, MVR Cancer Centre and Research Institute, Kozhikode, Kerala, India
Amyloid deposits
Apple green birefringence
Case #197
Lung nodules - H&E
Congo red - polarizing microscopy
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Schema of NSIP pattern
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NSIP pattern on HRCT
Contributed by Akira Yoshikawa, M.D.
Low power
Uniform involvement
Less inflamed
Lymphocytic infiltration and fibrosis
Lymphoid follicles with germinal center
Lymphoplasmacytic infiltration
Low power
Uniform involvement
Sparse architectural distortion
Peribronchiolar metaplasia
A few honeycomb changes
Dense fibrosis
Low power
Uniform involvement
Lymphocytic infiltration and fibrosis
Pleuritis
Organizing pneumonia
Lymphocytic aggregation
Airway centered change
Low power
Uniform involvement with lymphoid follicles
Lymphoid follicles with germinal center
Pleuritis with lymphoid follicles
Dense fibrosis are sparsely seen
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Diffuse and uniform inflammation
Cellular NSIP
Fibrotic NSIP
Pleuritis
Organizing pneumonia in NSIP
Series of slides of fibrotic NSIP
Contributed by Kyriakos Chatzopoulos, M.D., Ph.D. and Kassiani Boulogeorgou, M.D.
Cytomorphology of NUT carcinoma
NUT abrupt keratinization
NUT immunostain
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Classification of interstitial lung diseases
Imaging patterns of cryptogenic organizing pneumonia
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Typical organizing pneumonia
Typical organizing pneumonia
Chest radiograph
Focal organizing pneumonia
Infiltrative organizing pneumonia
Contributed by Yale Rosen, M.D.
Pale area of nodular consolidation
Mass-like lesions
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Cryptogenic organizing pneumonia
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Patchy involvement
Fibroblast plug
Fibroblast plug
Fibroblast plug
Fibroblast plug
Fibroblast plug
Mononuclear cell infiltrate
Foamy macrophages
Cicatricial variant
Cicatricial variant
Cryptogenic organizing pneumonia
Focal organizing pneumonia
Fibrosing organizing pneumonia
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Pulmonary nodule
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Bulging mass
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Histology of nodule
Lung tumor cells
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CT of clear cell tumor of lung
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Well circumscribed tumors
4 cm, gray-white, circumscribed tumor
confined to the lower lobe under the pleura
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(A) Core needle biopsy shows neoplastic cells in nested and insular pattern surrounding numerous thinned wall sinusoid-like vessels
(B) intranuclear cytoplasmic invaginations
(C) HMB45+ staining
Tumor with malignant histology
Various images
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Benign sclerosing perivascular
epithelioid cell tumor (PEComa)
(A) Large, irregular, cohesive clusters of columnar and spindle-shaped cells in background of single naked nuclei (Pap)
(B) several large clusters with open cribriform-like spaces (Pap)
(C) spindle-shaped and polygonal cells with round to oval nuclei and vacuolated ill-defined cytoplasm (Pap)
(D) cell block shows neoplastic cells arranged in a nested and insular pattern surrounding sinusoid-like vessels; inset shows sinusoid-like vessel amidst tumor
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Enhanced and nonenhanced CT scan
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Cut surface shows a well defined
mass, whitish to yellowish,
partly myxoid, solid and cystic
Contributed by Roseann Wu, M.D., M.P.H.
Various images
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Metastasizing tumor with benign features
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CT of lung nodule
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Endobronchial tumor
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8 x 7 cm tumor
Contributed by Roseann Wu, M.D., M.P.H.
Giant cell CA lung HE
Giant cell CA lung HE
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8 x 7 cm tumor
Diffuse proliferation of atypical, giant and bizarre cells
Contributed by Roseann Wu, M.D., M.P.H.
Giant cell CA ThinPrep
Contributed by Aliya N. Husain, M.D.
Cystic lesion chest CT
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CXR, CT PPB type III
CT PPB type I - III
CT PPB
Contributed by Erdener Özer, M.D., Ph.D.
Type III PPB
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Cross section PPB type IR
Cross section PPB type II
Contributed by Aliya N. Husain, M.D.
Benign epithelial cyst lining
Benign immature mesenchymal cells
Cyst with mature cartilage
Solid tumor with cyst
Cyst with solid tumor
Poorly differentiated solid tumor
Rhabdomyo-
sarcomatous
differentiation
Solid tumor with cartilage
Atypical mitotic figures
Rhabdomyo-
sarcomatous
differentiation
with desmin
Rhabdomyo-
sarcomatous
differentiation
with myogenin
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Aspiration cytology
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Plexiform lesion
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Life cycle
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Chest imaging
Bilateral well defined cystic spaces in lung
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Confluent consolidation and fine porosity
Contributed by Aliya N. Husain, M.D.
Intra-alveolar Pneumocystis jirovecii organisms
Granulomatous inflammation
Foamy amorphous material
Intra-alveolar Pneumocystis organisms
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Bronchoalveolar lavage washings
Contributed by Roseann Wu, M.D., M.P.H.
Moderate to severe dysplasia
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Various images
Normal bronchial mucosa
Contributed by Hongxing (Simon) Gui, M.D., Ph.D.
Endobronchial mass
Contributed by Hongxing (Simon) Gui, M.D., Ph.D.
Nodular mass
Reticular pattern
Multinodular growth
Spindle cells
Hybrid patterns
Angiomatoid fibrous histiocytoma area
Spindle cells in lacy pattern
Contributed by Yale Rosen, M.D.
Pseudomonas pneumonia
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Most common histologic patterns
Contributed by Andre L. Moreira, M.D., Ph.D.
Contrast CT: filling defect
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Transesophageal echo (TEE): large mobile masses
Echo: masses below pulmonary valve
Contrast CT: filling defect
CT showing filling defect
CT: filling defect
Intense avidity on PET
CT: multiple lung nodules
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Glossy white tumor, pulmonary trunk
Intraoperative images of tumor
Contributed by Andre L. Moreira, M.D., Ph.D.
Pulmonary artery with tumor
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Mass mimicking saddle pulmonary embolism
Yellow solid tumor mass
Occlusion, main pulmonary artery
Filling arterial branches (arrows)
Distending arterial branches (arrows)
Contributed by Andre L. Moreira, M.D., Ph.D. and Borislav A. Alexiev, M.D. (Case #535)
Atypical spindle cell neoplasm
Atypical spindle cells arranged in fascicles
Atypical spindle cells
Atypical spindle cells, fascicles
High grade nuclei, mitoses
Polypoid tumor with fibrin
Tumor in fibrin
Tumor in artery wall
Atypical mitoses
Myxoid and hypocellular areas
Nuclear pleomorphism
Tumor necrosis
Vascularity within tumor
Smooth muscle actin IHC
MDM2 IHC
Mimicker of blood clot
Mimicker of organized clot
Mimicker of IMT
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Clusters of spindled cells in PAIS
Pleomorphic cells with vacuolated cytoplasm
Pleomorphic spindle cells in PAIS
Contributed by Borislav A. Alexiev, M.D. (Case #535)
MDM2 gene in red
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FISH study with MDM2
Cardiac: MDM4 and CDK6
MDM2 FISH
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Mass near hilum
Compression of vena cava
Uptake within mass
Right mass
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Solid mass
Hemorrhagic mass
Contributed by Hongxing Gui, M.D., Ph.D. and University of Michigan Virtual Slide Box
Epithelial and mesenchymal components
Glandular epithelium and blastematous stroma
TTF1
Vimentin
Beta catenin
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Category 1 pulmonary hypertension
diagnosed postmortem as secondary to
pulmonary capillary hemangiomatosis (PCH)
Category 1 pulmonary hypertension
due to a second case of pulmonary
capillary hemangiomatosis
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Left lung with pulmonary parenchyma
Contributed by Yale Rosen, M.D.
Pulmonary veno-
occlusive disease -
Capillary dilatation
Pulmonary capillary hemangiomatosis
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(A)small veins demonstrate marked myointimal thickening; adjacent alveolar septa are
thickened by endothelial cell proliferation of pulmonary capillary hemangiomatosis;
(B) CD31 highlights endothelial cell proliferation
Pulmonary capillary hemangiomatosis
Contributed by Jeffrey P. Kanne, M.D.
With calcifications
CT scan
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Bronchoscopy
Large endobronchial mass
Contributed by @Andrew_Fltv on Twitter
Pulmonary hamartoma
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Pneumonectomy specimen
Firm and discrete lesions
Resected endobronchial tumor
Contributed by Hui-Hua Li, M.D., Ph.D. and Jefree J. Schulte, M.D.
With cartilage
Fat rich
Typical features
Fat / myxoid stroma
Bland spindle cells
Core biopsy
Biopsy, cartilage
Biopsy, epithelium
Contributed by @Andrew_Fltv on Twitter
Pulmonary hamartoma
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FNA smears
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Atherosclerosis
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Massively dilated bullae
Fatty infiltration
Contributed by Jian-Hua Qiao, M.D.
Foci of subpleural bullous emphysema
Clusters of mature placental chorionic villi-like structures
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Fatty infiltration
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Rhodococcus
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Transmission electron
micrograph of
Sin Nombre hantavirus
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RB-ILD chest radiograph and CT scan
Contributed by Kristine Konopka, M.D.
Macrophage accumulation
Smoker's macrophages
Iron stain
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Giant cells
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Some HRCT patterns
Contributed by @AKhannaMBBS on Twitter
Sarcoidosis
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Hilar lymphadenopathy in sarcoidosis
Contributed by Aliya N. Husain, M.D. and @AKhannaMBBS on Twitter
Multinulceated giant cells and fibrosis
Granuloma with asteroid body
Mediastinal node with granulomas and fibrosis
Granulomas of bronchovascular bundle and pleura
Granulomas with fibrosis
Sarcoidosis
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Well defined nodular lesion in peripheral lung
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Well demarcated hemorrhagic peripheral lung lesion
Contributed by Matthew J. Cecchini, M.D., Ph.D. and Pooja Navale, M.D.
Core needle biopsy with various growth patterns
Core needle biopsy with 2 cell population
Well demarcated lesion
Solid growth architecture
Papillary architecture
Hemorrhagic areas
Prominent foamy macrophages
Whole mount view
Solid tumor
Surface cells and round cells
TTF1 highlights both cell populations
Pancytokeratin highlights the surface cells
TTF1
EMA
CAM 5.2
Sclerosing pneumocytoma in small biopsy
Sclerosing pneumocytoma in resection
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ILS as seen at surgery
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Xray
Ultrasound
CT scan
Contributed by Jennifer Pogoriler, M.D., Ph.D.
ILS with systemic vessel
Cut surface ILS with systemic vessel
ELS and feeding vessel
Cut surface of ELS
ELS with prominent lymphatics
ELS with cystic changes
Contributed by Jennifer Pogoriler, M.D., Ph.D.
ILS aberrant hilum
Normal lung adjacent to ILS
ILS with parenchymal maldevelopment
Cystic changes in ELS
ELS with prominent lymphangiectasia
Skeletal muscle in septa
High power skeletal muscle
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Silicotic nodule
Silica crystals (polarized light)
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Right hilar mass
Left hilar mass
Contributed by Carolyn Glass, M.D.
Central tumor with bronchial spread
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Hilar mass
Central tumor
Spreading along bronchi
Contributed by Carolyn Glass, M.D.
Sheets of tumor cells
Crushed blue cells
Cellular morphology
CK7
TTF1
CD56
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Pedunculated mass
Contributed by Roseann Wu, M.D., M.P.H.
Images hosted on other servers:
Various images
Solid mass
Schneiderian papilloma
Bronchial papilloma
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Cytomorphology
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Central mass with cavitation
Peripheral mass with collapse
Contributed by @yro854 and @Andrew_Fltv on Twitter
Squamous cell carcinoma
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Central cavitation
Tumor obstructing bronchus
Tumor extending to pleura
Contributed by Alex McGeough, M.D. and Andrey Bychkov, M.D., Ph.D.
Tumor budding
Well differentiated
Intercellular bridging
Intratumoral necrosis
Poorly differentiated
Moderately differentiated
Prominent cytologic atypia
Keratin pearls
Basaloid type
Palisading nuclei in basaloid type
p40 positive in basaloid type
Bronchial biopsy
Nonkeratinizing
p40 staining
CK 5/6
SCC cocktail
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Keratinization and tadpole cell
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Right main bronchus
under a) white
light and b) auto-
fluorescence
Contributed by Gheorghe-Emilian Olteanu, M.D., Ph.D., Ana Mataić, M.D. and Luka Brčić, M.D., Ph.D.
Normal respiratory epithelium
Normal respiratory epithelium and SCIS
Upper layer spot necrosis
Flattening of the upper layer
Polypoid growth pattern
Pleomorphic cells
SCIS histopathology - lung, bronchus
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Staging chart
Staging animation
Updates on TNM staging (2017)
8th TNM classification (2018)
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Life cycle
Case #133
Small bowel infection
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Small bowel infection
Contributed by anonymous
Bronchial wash
Pap stain
Diff-Quik
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Bronchial wash
BAL fluid
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Hyperacute lung transplant rejection
Acute rejection (A1)
Restrictive allograft syndrome
Contributed by M. Ángeles Montero-Fernández, M.D., Ph.D.
Explant lung with diffuse alveolar damage
Idiopathic pleuroparenchymal fibroelastosis
Chronic lung allograft dysfunction
Contributed by M. Ángeles Montero-Fernández, M.D., Ph.D.
Alveolar septal capillaritis
Minimal acute cellular rejection (A1)
Moderate acute cellular rejection (A3)
Severe acute cellular rejection (A4)
Lymphocytic bronchiolitis (B2R)
Obliterative bronchiolitis
Acute fibrinous and organizing pneumonia
Acute lung injury
C4d
Indications, patient selection and outcomes
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Mycobacterium tuberculosis infection
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Chest Xray and high resolution CT of active tuberculosis
Contributed by Sajna V.M. Kutty, M.D.
65 year old male chronic smoker with 3 cm lung mass
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Lung with cavity and caseous necrosis
Histomorphologic
patterns of
postprimary
tuberculosis
Contributed by Hui-Hua Li, M.D., Ph.D., Jefree J. Schulte, M.D. and Aliya N. Husain, M.D.
Necrotizing granuloma core biopsy
Giant cells
Large necrotizing granuloma
Necrotizing granuloma
Positive AFB stain
Contributed by @AnaPath10 on Twitter
Tuberculosis
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Lymph node tuberculosis
Lymph node tuberculosis
Case of pulmonary tuberculosis with granulomas
Histopathology of pulmonary tuberculosis
Contributed by Philippe Joubert, M.D., Ph.D. and Case #266
CT scan: endoluminal tumor
Central carcinoid tumor
Contributed by Simon Martel, M.D.
Bronchoscopy: endoluminal tumor
Contributed by Sylvain Trahan, M.D. and Yale Rosen, M.D.
Endoluminal tumor
Peripheral tumor
Large polypoid tumor
Contributed by Philippe Joubert, M.D., Ph.D., Jijgee Munkhdelger, M.D., Ph.D. and Andrey Bychkov, M.D., Ph.D.
Endobronchial carcinoid
Rosettes
Trabecular and solid
Solid and zellballen
Trabecular
Pseudorosettes
Pseudogland formation
Salt and pepper chromatin
Spindle cell features
Focal cytologic atypia
Clear cells
Stroma ossification
High vascularization
Lymph node metastasis
Lymphovascular invasion
Submucosal nodule
Uniform small cells
Uniform small cells
AE1 / AE3
CD56
TTF1
Ki67
Typical carcinoid immunoprofile
Contributed by Philippe Joubert, M.D., Ph.D.
Loosely cohesive groups
Cells branching around a capillary
Rosette-like structures
Chromatin detail
Cell block
Typical carcinoid tumor
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Schema of UIP pattern
IPF diagnosis by lung biopsy and HRCT
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Usual interstitial pneumonia (UIP) pattern
UIP and possible UIP pattern
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Honeycomb lung
Cobblestone appearance of the pleura
Contributed by Akira Yoshikawa, M.D. and Yale Rosen, M.D.
Spatial heterogeneity
Spatial heterogeneity
Subpleural fibrosis
Subpleural and paraseptal fibrosis
Paraseptal fibrosis
Dense fibrosis
Dense fibrosis with architectural destruction
Honeycomb change
Honeycomb change
Honeycomb change
Fibroblast focus
Fibroblast focus
Fibroblast focus
Peribronchiolar metaplasia
PAP-like change
Respiratory bronchiolitis
Squamous metaplasia
Fat metaplasia
Bone metaplasia
Elastosis
Usual interstitial pneumonia
Usual interstitial pneumonia
Usual interstitial pneumonia
Contributed by Matthew J. Cecchini, M.D., Ph.D. and Brandon T. Larsen, M.D., Ph.D.
Ground glass & consolidation
Ground glass
Contributed by Matthew J. Cecchini, M.D., Ph.D. and Brandon T. Larsen, M.D., Ph.D.
Diffuse alveolar damage
Acute lung injury with organizing pneumonia
Acute fibrinous pneumonitis
Bronchiolitis
Foamy change
Cagle: 2015
Churg: 2019
Duarte Achcar: 2016
Fraig: 2015
Husain: 2021
IAC-IARC-WHO: 2023
IARC: 2015
IARC: 2021
Jiang: 2023
Katzenstein: 2016
Mukhopadhyay: 2016
Mukhopadhyay: 2023
Papotti: 2015
Popper: 2016
Smith: 2023
Suster : 2020
Suster: 2022
VandenBussche: 2019
VandenBussche: 2017
Zhang: 2018
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