LIST OF SPECIMENS

#1 Colon Cancer invasion into bladder (No utah images available)

#2 Benign Breast UDH (usual ductal hyperplasia)

#3 Invasive Ductal CA - Breast

#4 Ovary Adult Granulosa Tumor

Primitive Follicle
Call Exner Body

#5 Ovary LG Serous CA (Serous ovarian CA, ovarian serous adenocarcinoma, papillary serous + psammoma bodies,
serous cystadenocarcinoma low grade with psammoma bodies, papillary serous cystadenocarcinoma gross x 2)

#6 Ovary with Metastatic Colon CA (advanced stage colorectal adenocarcinoma)

Features favoring metastases from colon include: bilateral involvement, surface involvement, infiltrative pattern of growth, signet
ring cells, cribriform growth, dirty necrosis, vascular invasion, and lack of squamous metaplasia. [CK7-, CK20+, CEA+, CA-125-,
MUC2+, CDX2+ and beta-catenin +]

#7 Ovary Benign Serous Cyst (Serous cystadenoma gross x2, benign cystadenoma opened to show multiloculation)

#8 Breast Invasive Lobular CA-ILC (Indian filing)

#9 Colon Small Intestine with Diverticulosis

#10 Colon Adeno Cancer (neoplastic glands of adenocarcinoma have crowded nuclei with
hyperchromatism and pleomorphism. No normal goblet cells are seen.)

Irregular, crowded glands containing bluish mucin

#11 Breast IDC (Refer to #3)

#12 Thigh - Osteosarcoma (osteosarcoma is composed of spindle cells. The pink osteoid formation seen
here is consistent with differentiation that suggests osteosarcoma.)

#13 Complete Mole (grapelike chorionic villi, atypical trophoblastic proliferation, but chorionic villi are still present.

#14 Placenta Percreta with fetus (postop view of uterus showing spontaneous rupture (arrow) due to placenta percreta)

(no Utah images)

#15 Ovary Teratoma mature - variety of mature, well-differentiated tissue elements may be found from all three
embryologic germ layers (ectoderm, mesoderm, endoderm), aka dermoid cysts ectoderm elements ie. Hair
Microscopically, this teratoma is seen to have cartilage as well as adipose tissue and even intestinal
glands at the right, while at the left are a lot of thyroid follicles

#16 Cervix SCC - fungating red to tan to yellow mass that obscures the cervical os

Spread to vagina/Stage 4 pelvic exenteration

Low power nests of

SCC infiltrating stroma

#17 Axilla Lymphoma (No utah images available)

High power: Keratin pearls

#18 Thyroid Follicular Cancer (Adenoma, gross x2)

Micro: Normal thyroid follicles appear at the lower right. The follicular adenoma is at the center to upper left.
This adenoma is a well- differentiated neoplasm because it closely resemble normal tissue with colloid

#19 Ovary Benign Serous Cyst refer to #7

#20 Kidney Hydronephrosis

Advanced, with thin

rim of remaining cortex

Focal hydronephrosis (dilated collecting system) in

lower pole of kidney due to stone obstruction

#21 Colon Normal (crypts with numerous goblet cells)

#22 Uterus Endometroid Adeno CA

Dilated kidney due to stone

in utero-pelvic junction

The EAdenoCA in the polyp (left) is moderately differentiated, with discernible

glandular structure. Note the hyperchromatism and pleomorphism of the cells,
compared to the underlying endometrium with cystic atrophy at the right.

The glandular and cribriform endometrioid pattern fits with type I endometrial
CA. This neoplasm is superficially invasive into the myometrium at the right.

#23 Liver Cirrhosis

(macronodular >3mm, commonly caused by hepatitis B/C)

(micronodular <3mm, commonly caused by chronic alcoholism, yellowish hue due to fatty change, AST>ALT)

(Microscopically, the regenerative nodules of hepatocytes are surrounded by fibrous connective tissue that bridges between portal tracts. Also note
macrovesicular steatosis/fatty change on the left.)

#24 Cecum - Perforated (distal large bowel obstruction, unrelieved cecal volvulus, trauma to the right side of abdomen, or ingested foreign bodies)

#25 Penis SCC (reddish-tan with ulcerated surface, non-circumcision is a risk factor)

#26 Lung Saddle Pulmonary Embolus (usually from large veins of the legs)

#27 Uterus MMMT- carcinosarcoma: Adenocarcinoma (endometrioid, serous, clear cell) mixed with malignant mesenchymal (sarcoma) elements

Note areas with osteosarcoma

#28 Colon Adeno Cancer with Mucinous Features

Mucinous adenocarcinoma showing

abundant extracellular mucin

#29 Uterus Leiomyomata (can be submucosal, intramucosal, subserosal, can be very large, but benign)

Normal myometrium is at the left, well-differentiated

leiomyoma at the right hardly appears different. Bundles of
smooth muscle are interlacing in the tumor mass

#30 Breast IDC Poorly differentiated (Refer to #3)

#31 Uterus Leiomyomata + Adenomyosis (serosal surface of myometrium), Adenomyosis occurs when endometrial glands
and stroma are found in myometrium, not just in endometrium where they belong. This condition leads to uterine enlargement and irregular bleeding.

Thickened and spongy appearing myometrial wall typical of

adenomyosis, with small white leiomyoma at the lower left

These glands are lined by endometrial epithelium & surrounded

by a small amount of endometrial stroma = focus of adenomyosis.

#32 Kidney ESRD-end Stage renal dz (bilateral, small kidneys)

ESRD: The cortex is fibrotic, the
glomeruli are sclerotic, there are
scattered chronic inflammatory cell
infiltrates, and the arteries are
thickened. Tubules are often dilated
and filled with pink casts and give an
appearance of "thyroidization."

#33 Uterus Leiomyosarcoma -more cellular & more pleomorphism and hyperchromatism than benign leiomyoma. Spindle cells + mitoses,
with occasional giant cells seen in sarcomas (including leiomyosarcoma)

#34 Ovary Fibroma (type of ovarian stromal tumor, hard and white)

#35 Breast ILC invasive lobular Ca (Refer to #8)

#36 Vagina Leiomyosarcoma (vulva) (No utah images available)

#37 Breast IDC (Refer to #3)

#38 Kidney Obstruction + Stones (most often calcium oxalate ~75% , struvite/staghorns are made of magnesium ammonium phosphate ~12%)

Staghorn calculus

#39 Heart Hypertrophy + aorta with atherosclerosis

Atherosclerotic
aortic aneurysm

mild, moderate, and severe atherosclerosis from bottom to top

Fatty streaks first signs of

atherosclerotic development

#40 Ovary Mature Teratoma (Refer to #15)

#41 Heart Hypertrophy

Bulging of large intraventricular septum into LV chamber

Hypertrophy in patient with hypertension

Cardiomyopathy: Hypertrophy of myocardial fibers and

interstitial fibrosis

#42 Heart Hypertension (Refer to #41)

#42 Lung - Lobar Pneumonia

Entire left upper lobe

Lower lobe consolidation

#43 Heart CHF (No utah images available)

Left sided CHF

LV hypertrophy in patient with hypertension

#43 Lung CHF

Pulmonary congestion with dilated capillaries and leakage of blood into alveolar spaces leads to an increase in hemosiderin-laden
macrophages. Brown granules of hemosiderin from break down of RBC's appear in the macrophage cytoplasm. These macrophages are
sometimes called "heart failure cells" because of their association with pulmonary congestion with congestive heart failure.

#44 - Breast DCIS (no Utah images)

Low grade DCIS

#45 Breast invasive papillary carcinoma w/ Hematoma (No Utah, also cant find a pic with a hematoma)

Many cases have areas of fibrosis, recent or

remote hemorrhage, or inflammation

#46 Colon carcinoma (6 cm)

Polyps >2cm makes possibility of malignancy more likely

A microscopic comparison of normal colonic mucosa on the left and that

of an adenomatous polyp (tubular adenoma) on the right is seen here.
The neoplastic glands are more irregular with darker (hyperchromatic)
and more crowded nuclei.

#47 Heart CHF (Refer to #43)

#48 Uterus w/ Fibroids (Refer to #29)

#49 Lung Bronchial Asthma

Between the bronchial cartilage at the right and the bronchial lumen filled
with mucus at the left is a submucosa widened by smooth muscle hypertrophy, edema,
and inflammation (mainly eosinophils).

eosinophils are prominent from their bright red cytoplasmic granules

This cast of the bronchial tree is formed of inspissated mucus and

was coughed up by a patient during an asthmatic attack. The
outpouring of mucus from hypertrophied bronchial submucosal
glands, the bronchoconstriction, and dehydration all contribute to
the formation of mucus plugs that can block airways in asthmatic
patients.

#50- Heart myocardial infarct

LV wall with recent MI, Center =

yellow necrotic muscle surrounded
by a zone of red hyperemia

Transmural MI of LV and septum

1-2 days: Dark red contraction bands, myocardial nuclei almost

disappeared, hemorrhage with myocardial fiber necrosis

1-2 weeks: many macrophages with numerous

capillaries and little collagenation (normal
myocardial fibers at top)

Contraction band necrosis

seen on first day of MI

Rupture of the myocardium

3-4 days: Extensive acute inflammatory cell

infiltrate + neutrophil karyorrhexis, No nuclei visible

3-4 weeks: decreasing cellularity, more prominence of collagen

#51 Heart coronary artery disease

Complex atheroma w/ calcification

Thrombosis in narrowed artery, Needle

like spaces = cholesterol clefts

Cholesterol clefts and foam cells

#52 Lung Bronchopneumonia

Patchy tan yellow consolidation

#53 Heart Remote MI, CAD, cardiomegaly

Pale fibrosis + collagenation (post-MI healing),

Minimal cellularity, collagen scar = noncontractile

Remote MI in anterior LV free wall and septum;

endocardial surface shows extensive scarring

#54 Heart Fibrinous Pericarditis

Shaggy fibrinous exudate: bread and
butter or carpet appearance;
Friction rub heard on physical exam
Friction

Strands of fibrinous exudate

Strands of pink fibrin extend outward

with underlying inflammation

Normal glistening wall

obscured by pink-tan fibrin

#55 Ovary Infarcted tumor (Brenner): Solid to partly cystic epithelial nests surrounded by stroma composed of bundles of tightly packed spindle-shaped cells. The epithelial
cells are polygonal and of squamoid type, with pale, eosinophilic cytoplasm and oval nuclei with distinct nucleoli and longitudinal grooving, which is commonly described as "coffee-bean" in appearance

Gross: firm yellow-white, often circumscribed

Infarcted tumor + central calcification

Sharply demarcated, sectioned

surface with thecoma-like yellow hue

#56 Bladder: leiomyosarcoma of bladder (no Utah)

Spindle cells with cigar-shaped nuclei, bright

eosinophilic cytoplasm, mitoses, nuclear atypia

#57 Breast IDC/DCIS (no Utah)

DCIS vs IDC

#58 Testicle Acute/chronic Inflammation (neg for tumor)

Mumps Orchitis: focal atrophy of tubules

Inflammation causes testicle atrophy with

loss of germ cells and interstitial and
peritubular fibrosis
infertility

Inflammation can cause hydrocele

fluid in tunica vaginalis

#59 Heart Part I CAD+hypertension (no liver no lung in container) Refer to #51
Part II liver cirrhosis, lung pneumonia Refer to #23 and #42 or 52
#60 Lung Bronchopneumonia (Refer to #52)
#61 Heart - Stroke no brain normal organs (No idea what this means)
#62 Kidneys Glomerulosclerosis (GS)

Nodular GS, aka: Kimmelstiel Wilson lesion a/w diabetes. Pink hyaline in glomerular capillary loops, increase in mesangial matrix, basement membrane thickening

#63 Lung - Pulmonary Embolism not seen, normal organs

Small peripheral pulmonary artery thromboembolus

with a small recanalized channel (asymptomatic)

Thromboembolus with pale pink lines of Zahn

The fibrous bands of connective tissue across this

recanalized pulmonary arterial branch indicate organization
of a remote pulmonary thromboembolus

#64 Heart - Heart with old MI normal organs (refer to #50)

#65 Heart - CHF, bilateral, hypertrophy, pulmonary Edema, Copd
#66 Heart - enlarged heart, old MI, aorta, endocarditis, kidney GS. S/p Bypass

#67 Heart - S/p Bypass/ enlarged heart with pacemaker

#68 Lung - Severe Bronchopneumonia with Abcesses (usually due to S. Aureus)

#69 Heart - enlarged heart, calcified aorta

Calcified aortic valve

#70 - Bilateral ovarian mucinous adenoca kidney (no Utah)

#71 Clear cell RCC renal cell carcinoma (VHL tumor suppressor gene mutation in 75% of cases). Paraneoplastic
syndrome = hypercalcemia

Cystic RCC with hemorrhage

RCC in lower pole, yellow/white

Clear cell RCC- nests with intervening blood vessels

seen with VHL mutation
VH

Can invade renal vein, and go up

the vena cava to the heart. Can
also invade the renal capsule

Less common papillary variant with MET mutation

Note the eosinophilic cytoplasm
Note

#72 Stomach GIST from interstitial cells of Cajal; The vast majority of GISTs carry a mutation either in the gene for
Seen kinase c-KIT (80% of cases) or platelet-derived growth factor receptor alpha (PDGFRA; 8% of cases)
tyrosine

Spindle cells arranged in broad fascicles

Spindle cells arranged in broad fascicles (higher mag)

Epithelioid variant GIST

#73 Stomach GIST (refer to #72)

#74 Stomach Schwanomma (S100+, spindle cell mesenchymal tumors, which originate from any nerve that has a Schwann cell sheath)
Exophytic submucosal mass

Nuclear palisading

Histologic details of gastric schwannoma. A. Tumor cells show a microtrabecular architecture with interspersed fibromyxoid matrix. B. An example with a more solid
to fascicular pattern. C. Focal nuclear palisading. D. Moderate nuclear atypia was often focally present

#75 Testicle Seminoma lobulated soft tan/brown tissue: The serum markers of greatest value include: lactate dehydrogenase
isoenzyme 1 (LD1), alpha-fetoprotein (AFP), and human chorionic gonadotropin (HCG). The highest stage has the highest LD1.

Normal testis to the left seminoma on right. Lymphoid

stroma between nests of seminoma

Lobules of neoplastic cells with intervening stroma filled with lymphocytic infiltrate.
Seminoma cells are large with vesicular nuclei and pale watery cytoplasm.