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

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

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

Parasagittal section through total laryngectomy specimen resected for advanced stage squamous cell carcinoma. Curious finding in the blue box #PathSky #Pathology #ENTPath #HeadNeckPath #EmoryPathology

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

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

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

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

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.

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

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

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.