Kelly Magliocca DDS, MPH

50s yom maxillary sinus
Dx: sinonasal papilloma, inverted-type
📸macro: partially translucent mass w/cerebriform opaque infoldings
📸low: downward growth of epi
📸 mucous cells (arrow) & microabscess formation
📸 thick squamous epi w/transmigrating neutrophils

#Pathsky #Otosky #ENTsky #macromicropath

60’s male, parotid mass
Dx: Warthin tumor
📸macro: cystic-solid mass, note layering of cystic contents for gross-micro correlate [arrow]
📸low mag overview [arrow for gross-micro reference]
📸papillary projections w/lymphoid stroma
📸bilayered oncocytic epithelium

#PathSky #Otosky #PathTwitter #ENTsky

Permanent slide sections of this parotid mucoepidermoid carcinoma (MEC) better demonstrate areas of oncocytic/oncocytoid change. Intermediate cells smaller, more hyperchromatic. Mucous cells scattered throughout.

Note: identification of all 3 cell ‘types’ is not required for a dx of MEC.

#PathSky

Higher magnification of the original frozen section slides: infiltration with aggressive growth pattern, squamoid/oncocytic nests, foci with mucous cells. Tumor is high-grade.

MAML2 rearrangement detected by FISH.

Frozen-section-Friday

40’s FM parotid mass

Dx: mucoepidermoid ca

📸 macro: ill defined borders, largely solid, focal cystic (arrowhead). Parotid node (solid arrow) and skel.muscle (open arrow)
📸 touch prep: clusters polygonal cells w/dense cytoplasm
📸 scan mag appearance

#PathSky #ENTSky #Radsky #Otosky #PathTwitter

40s male w/fullness & pruritus of left external auditory canal. Exam with gray-white material (removed), tympanic membrane intact.

Dx: Otomycosis

📸 low mag profile of fungus ball
📸 fruiting body among hyphae & detached keratin debris
📸 addit’l fruiting bodies (Aspergillus sp)

#PathSky #Otosky

Mid-40’s male w/nasal obstruction

Dx: allergic fungal sinusitis (polyps not shown)

📸 layering of mucin, cellular debris, degranulated eosinophils & inflammatory cells
📸 Charcot-Leyden crystals (arrows)
📸 occasionally fungal forms visible on H&E (arrow)
📸 fungus readily highlights w/GMS
#PathSky

Image of the Week!

Contributed by: Kelly Magliocca, D.D.S., M.P.H.
Textbook topic: Mandible & maxilla
Diagnosis: Ameloblastic carcinoma
Textbook topic link: www.pathologyoutlines.com/topic/mandib...

#Pathology #PathologyOutlines #PathSky

📸 Amazing how the background parotid tissue fills in so nicely on permanent sections (it is the same block! I promise!) Can better appreciate variations in cellularity and patchy hemorrhage that contribute to the gross appearance
📸 chondroid matrix, ducts and myoeps on permanent sections

#PathSky

📸 frozen section, tumor capsule
📸 frozen section, epithelial cells (ducts) and myoepithelial cells
📸 frozen section, nests of myoepithelial cells in myxochondroid matrix

Dx: pleomorphic adenoma

#Pathsky

Frozen-section-Friday:

Adult with 2 cm parotid mass sent for intraoperative consultation

📸: solitary, largely circumscribed, cut surface w internal heterogeneity
📸: touch prep - monotonous cells (myoeps) w/i basophilic matrix
📸: low mag nodule contour at frozen section

…next

#PathSky #ENTsky

Folliculocentric dyskeratotic process w/warty surface keratosis, suprabasal clefting, villous rete & dyskeratotic cells [corps ronds (round) and grains (flat)]

#dermpath #Pathsky #ENTsky #Otosky

Partial auriculectomy for basal cell carcinoma (not shown) in pt with known history of Darier disease

📸 macro: portion of helix, formalin-fixed with multiple punctate lesions (arrow) and small plaques
📸 macro, cut-surface: firm, rust/white colored plaques confined to epidermis

#dermpath #Pathsky

ThC: thyroid cartilage, FC: false cord, TC: true cord, ELE: extralaryngeal extension

Parasagittal section through total laryngectomy specimen resected for advanced stage squamous cell carcinoma. Curious finding in the blue box

#PathSky #Pathology #ENTPath #HeadNeckPath #EmoryPathology

B: bacteria in the low mag picture. Pt likely has an underlying laryngeal chondronecrosis.

These tyrosine-like crystalloids seem to localize most frequently to the true cord, particularly near the macula flava

PMID: 39177813

Biopsy of anterior true vocal cord, sent for intraop consult. Pt with history of glottic squamous cell ca, s/p radiation therapy. Biopsy neg for scca. However…

📸 tyrosine-like crystalloids w/i anterior macula flava (is chondroid here)
📸 TLCs not commonly seen at frozens

PMID: 39177813

#Pathsky

Adult male; White corrugated plaque on lateral oral tongue

Dx: oral hairy leukoplakia

Low: epithelial hyperplasia, shaggy corrugated parakeratotic surface, often pallor in spinous layer
High: perinuclear clearing, nuclear beading
EBV ISH (red): nuclear signal in affected cells

#PathSky

Solitary, exophytic nodule at posterior dorsal tongue.

Dx: lingual osseous choristoma

📸: oral mucosa with central focus of dense lamellar bone
📸: relation of bone to overlying oral squamous epithelium
📸: lamellar bone (slightly over-decal’d) with evidence of remodeling

#PathSky #ENTsky

Mid-30’s FM w/progressive conductive hearing loss. Clin dx: otosclerosis

Intraop: stapes fixed, remainder of ossicular chain mobile.

📸: stapes with remodeling, transected above footplate
📸: evolving pseudocyst w/i the articular surface (reactive)

#PathSky #ENTpath #PathTwitter #EmoryPathology

📸Transverse section through the cricoarytenoid joint (CAJ) of the larynx, a true synovial joint. Arrows delineate joint space
📸 Same, just higher mag
📸 Generally surfaced by fibrocartilage (but may be mixed). Synovium present
📸 Synovial lining

#PathSky #ENTPath #PathTwitter
#EmoryPathology

Pathologic staging = pT4a related to bone invasion (focally invades into submucosa/mucosa of maxillary sinus, no impact on pathologic stage though).

Squamous cell carcinoma of the edentulous alveolar ridge and palate. Cut surface (ms=maxillary sinus; nc=nasal cavity); corresponding low mag image; endophytic (arrow) with cystic cuniculatum-like growth; additional cystic change in scca.

#PathSky #ENTPath #HeadNeckPath #OralPath #PathTwitter

This particular case is high grade.

📸 tumor necrosis, solid growth, and increased mitotic rate (3 in this high power field alone).
📸 EWSR1 break apart FISH positive

#PathSky

Nasopharyngeal mass, adult male.

Dx: Hyalinizing clear cell ca.

➡️Nests of eosinophilic and/or clear cells. Helpful: 2 ‘types’ of fibrosis (dense hyalinization and fibrolamellar stromal fibrosis).

#PathSky #ENTsky #HeadNeckSky

Expansile sinonasal mass, adult FM:

Dx: Epithelial-myoepithelial carcinoma. Biphasic salivary gland carcinoma composed of tightly coupled eosinophilic ductal cells and abluminal myoepithelial cells. Diffuse RAS Q61R IHC expression supportive while working thru the ddx.

PMID: 33481388

#PathSky

Adult FM with temporomandibular osteoarthritis

Dx: Subchondral cyst (SC)

SC identified on sagittal CT & subsequently on microscopic examination. 📸➡️ TMJ SC is spherical subchondral lesion w/myxoid change surrounded by reactive bone. Articular cartilage with degenerative changes.

#PathSky #RadSky

DICER1-associated atrophic changes in this min. invasive FTC. Rim of pale, flattened tumor cells adjacent to non-affected tumor. Circumferential, no cellular debris, apoptotics or inflammation; argues against necrosis.

🙌 🙏 to author KV in PMID:38637342 for teaching me!

#PathSky #Thyroid #Endosky

Lytic lesion of mandible, prior extraction site; years ago.

Myospherulosis represents altered RBCs in cyst-like spaces, surrounded by fibrosis. At high magnification, note the pigmented spherical bodies (‘bag of marbles’). Potentially a fungal mimic ➡️ PAS/GMS neg.

#PathSky #OralPath #PathTwitter

Thank you 🙏