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 🙏

Hello! I’m an oral, head and neck pathologist and like to be included pls

Concentric layers of bacteria and debris: pics➡️Center of the calculus; layered regions; and two pics demonstrating the peripheral textured region of the calculus that originally caught my eye macroscopically

Submandibular sialolith is a gross-only specimen for us. However…the interesting surface texture piqued my interest. Intact appearance, sectioned, faxitron (in our lab) and low mag histology with arrows highlighting the textured region.

#PathSky #RadSky #OralPath #ENTPath #HeadNeckPath

SNP may (or may not?!) be distracting at intraoperative consultation. Below, an incidental focus in a en face margin of posterior-lateral oral tongue. The epithelium with taste buds is only a few layers thick and lacks a substantial surface keratin layer. Neural elements tough to see.

#PathSky

Will find SNP tissue (arrows in these two low magnification examples) near fungiform, foliate and/or circumvallate papillae of the tongue.

#PathSky #ENTPath #OralPath #HeadNeckPath #PathTwitter

At high magnification, subgemmal neurogenous plaque (normal regional microanatomy) may overlap with neurofibroma: spindle cells, buckled nuclei, collagenous stroma. Key clue: localization near taste buds (s100+/keratin+) in the overlying epithelium.

#pathSky #ENTpath #HeadNeckPath #EmoryPathology #Pathology

Sinonasal mass, adult. DEK::AFF2 sinonasal carcinoma, FISH+. We do not have this testing in-house, we used a reference lab in the US for this case. (Attached ancillary testing results were non-specific)

Other sites:
Middle ear/temporal bone: PMID: 32366754
Larynx PMID: 40299135
Lung PMID: 35773081

More recent paper describes a non-canonical fusion

#PathSky #Pathology #ENTPath #HeadNeckPath #EmoryPathology

Tracheal adenoid cystic carcinoma. At high magnification (next 2 pics), areas of ‘signet-ring like’ or vacuolated, clear cell change is noted in ducts. Unknown clinical significance but when present in small biopsy material, may lead to diagnostic uncertainty.

PMID: 23379326
PMID: 39235305 (fig 3)

Idiopathic gingival papillokeratosis with crypt formation.

Uncommon. Generally located along anterior maxillary gingiva in young people. Asymptomatic plaque(s), usually bilateral and white in color. No known risk of transformation.

PMID: 28089460

#PathSky #OralPath #ENTPath #EmoryPathology

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

PMID: 39177813

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

#PathSky #Pathology #ENTPath #HeadNeckPath #EmoryPathology

Endolymphatic sac tumor

#PathSky Laryngeal mass, older adult male. Primitive, highly vascular round cell neoplasm for the most part.