Listen, I know not everyone is an interested as I am in these things but this platelet is HUGE! It's surrounded by some normal-sized ones for reference. #hematology #pathsky

"Histologically aggressive" CLL Confluent proliferation centers (1st pic) or Ki-67 index >40%. Might see prolymphocyte-like morphology (2nd pic). Often associated with TP53 mutations (3rd pic; p53 IHC). The prognosis is poorer than usual CLL, so this is important to recognize! #hemepath #pathlsky

If the blood looks like the first photo (leukoerythroblastic: blasts, teardrop cells, nucleated RBCs), that's a hint that the marrow might look like the second photo - hypercellular with a streaming effect due to fibrosis. #hematology #hemepath #pathsky

Signet ring morphology in follicular lymphoma. This doesn't seem to have any significance in terms of lymphoma prognostication, but imagine seeing those on an FNA - one might be led astray 👀 #hemepath #pathsky #hematology

In hemepath, we spending a lot of time looking for neuroblastoma but not a lot of time actually seeing neuroblastoma, in my experience. Check out this case - the vacuolization had us thinking about Burkitt, but the IHC was all consistent with neuroblastoma. #hemepath #pathsky

One of my fabulous attendings sent out these Cellavision photos. Histo antigen was positive!

This turned out to be B-lymphoblastic leukemia but I had never seen a case with such crazy vacuolization! #pathsky #hemepath #hematopathology #hematology

Forgive my low quality snip of this during conference but this is the ONLY non-CAP malaria case I have seen in my training. "Banana" gametocytes of Plasmodium falciparum. 🍌 🦟 #hematology #pathsky

This young patient's blood was loaded with reticulocytes and polychromatic RBCs. I think it's cool how it gets a blue tinge. #hematology #pathsky

Nice rouleaux formation. You can see the central pallor on the single cells, so that tells us we're in a good place on the smear and this isn't likely to be artifact. Even less likely to be artifact when I tell you this marrow was 80% involved by PCN! #hematology #hematopathology #pathsky

This is a feature you can see in some lymphomas, especially high-grade. We don't usually consider lymphovascular invasion in hemepath, but look how it tracks the vessel! #pathology #hematopathology #pathsky

This is a frozen from the nasal cavity of a pt in their 20s and immunosuppressed. Invasive fungal sinusitis 😬

Even at low-power, this fibroid looks a little funny. Bizarre nuclei. I find the fumarate hydratase stain hard to interpret but the bizarre cells do appear FH deficient. This is a great case of FH-deficient leiomyoma. #pathsky

This was such a photogenic example from my fellowship director's unknowns that I had to steal it. A teenager with a femur lesion. DAT EMPERIPOLESIS THO! (Rosai-Dorfman disease) #thingspathologistssay #pathsky #hematopathology

This is an ulcerative soft palate lesion in an immunosuppressed patient. Keeping in mind that I'm a *hemepath* fellow....want to take a guess at what that non-H&E slide might be? #pathsky

Ever seen B-ALL in a kidney? Touch prep shows the cytology a little better. I found two poor tubules hanging on for dear life. Otherwise extensively infiltrated by what workup revealed to be B-ALL. #pathsky #hematopathology

This is a sentinel node from a melanoma resection. From low-power we can that there's no good intact nodal architecture, and we can appreciate some lighter proliferation centers in this lymphoid infiltrate. Yes, there is melanoma in this node, but also incidental CLL/SLL. #pathsky #hematopathology

Taking advantage of our digital archives before I change institutions Lung mass in a 50-ish pt. Great illustration of classic Hodgkin lymphoma. Scattered large atypical cells in a robust inflammatory background. Peep the Path Outlines on HL, authored by the person I stole this case from :D #pathsky

Just based on morphology, any thoughts about what lymphoid process might be sneaking into this marrow? 🌠 #hematopathology #pathsky #hematology #pathresidents

This patient has a confirmed history of mantle cell lymphoma. I hadn't seen many examples of circulating MCL so here ya go! #pathsky #pathology #lymphoma #hematopathology #hemepath

🦌 Staghorn nuclei in megakaryocytes In real life, this finding is nonspecific, but on the exam... Which myeloproliferative neoplasm characteristically shows "staghorn" nuclear morphology in megakaryocytes? #pathsky #pathresidents #hematopathology

So you're reviewing a lymph node excision and you're assessing this nodular lymphoid proliferation, but you notice a little nest in the lymph node capsule 👀🔍 What could it be? #hematopathology #pathsky

Never seen such a beautiful bone marrow core in all my days 😍 #hematology #pathsky #pathology #hematopathology

Microgranular/hypogranular acute promyelocytic leukemia: ✅ WBC 127K/uL ✅ Bilobed, "apple core" nuclei ✅ No significant cytoplasmic granularity ✅ FISH positive for PML::RARA fusion #pathsky #pathology #hemepath #hematopathology

Beautiful example of the cytoplasmic vacuolization or "string of pearls" morphology characteristic of Burkitt lymphoma in body fluids #pathsky #pathology #hemepath

Here's an interesting case of placental listeriosis. The inset shows the gram positive rods that cause this patchy necrosis and exudative inflammation. #pathsky #pathology #placentapath

Look closely for viral cytopathic effect in this high power view of a placenta. Which virus do you think is responsible? #placentapath #pathsky #pathology

Ugly necrotizing chorioamionitis in a placenta from a G6P1 pt at 19 weeks gestation with loss of fluid. This case also had dramatic funisitis. #placentapath #pathology #pathsky #histology

Picture-perfect "onion-skinning" in a case of primary sclerosing cholangitis 🧅 🧅 #pathsky #pathology #liverpath

Abdominal mass in a 1 year old male. This is a pretty classic example of Wilms tumor aka nephroblastoma. #GUpath #pedipath #pathsky

The wording of this diagnosis caught my eye in an old ppt. 32M h/o abd pain and diarrhea after ending steroid therapy for lupus. Histology shows suppurative inflammation limited to the submucosal layer. Phlegmonous enteritis is the given dx, though that seems to be an outdated term. #gipath #pathsky

This is a duodenal mass is a patient with inflammatory bowel disease presenting with 1 week of nausea and vomiting. What IHC do you want to order? #pathsky #pathology #histology

One could easily mistake these for histiocytes. But what if I told you these findings were associated with a flask-shaped ulcer in the cecum of a patient from Mexico? #microbiology #pathsky #pathology

Been poking through old unknowns conferences to keep surg path knowledge fresh during my hemepath fellowship. I found this striking case of gastric calcinosis from Dr. Beth Harris. This rare finding is seen with organ transplantation, atrophic gastritis, and antacids containing aluminum. #pathsky

Classic morphology in this patient with beta thalassemia plus some underlying liver disease. Target cells (aka codocytes) have excessive cell membrane compared to their cell volume, so the excess "bunches up" centrally. #hematology #PathTwitter #PathResidents #pathsky

The peripheral smear can give a preview of what you'll find in the marrow. Here we see a circulating blast, a nucleated erythrocyte, and anisopoikilocytosis with frequent teardrop cells. What do you think the marrow might look like? 🤔 #hematopathology #hemepath #hematology #pathsky

Ooh, found a nice one to share from the ol' PathTwitter account. The buzzword for this diagnosis is a "jigsaw" pattern of nested cells. Thoughts? #pathsky #dermpath #pathology

Pathologists, what's missing here? #pathsky #pathology #pedipath

Warming up to this new platform with a few of my favorite cases from PathTwitter. This is a myelolipoma with focal osseous metaplasia. "Boneless marrow" as Dr. Dennis O'Malley likes to call it! #pathsky #hematopathology #pathology

My 1st #pathsky post! Photogenic flame cells in a myeloma aspirate 😍 #hematopathology #hemepath #pathology