Cystadenoma of the ovary, Masson Trichrome. 

This cyst is an ingrowth on the ovary surface, the capsule tissue that normally surrounds the ovary is seen at right (light blue). As an adenoma it consists of epithelial cells derived from glandular ovarian tissue. The cavities of the glands fill with mucous produced by the epithelial cells. 

The other day, a coworker grossed one that was a 5kg beast. Cutting into it was interesting to say the least.

Chronic lymphocytic leukemia, peripheral smear.

90% of CLL cases occur in patients over 50 years of age. Picture perfect autoimmune hemolytic anemia (schistocytes, spherocytes, DAT positivity) presents in 15-35% of cases. Patients tend to survive for a very long time (5-20 years), and unlike CML, there is no blast crisis and they usually die of some other infection.

Its main hallmark is absolute lymphocytosis, and the lymphocytes have very clumpy chromatin that makes them look like soccer balls (alternatively, they all just break and you get a slide full of smudge cells). It’s extremely easy to pick out once you’ve seen it since, by lymphocytosis, I mean I had a patient today with a white cell count of 549x10^9/L (high normal is 11x10^9/L for our region). 

Acute Erythroblastic Leukemia, peripheral smear.

AEL is incredibly hard to miss when it comes up on a smear. Like all AMLs, it is a malignant expansion of precursor cells—in this case, red blood cell precursors. When doing a cell differential, the nucleated red cells are hugely elevated (by which I mean you can easily have more nucleated red cells than all the white blood cells combined where there should be very few if any in a normal smear).

An H&E section of a complete hydatiform mole, an abnormal pregnancy where a non-viable, fertilized egg implants in the uterus.

Semi related story time! I have a problem with people not screwing the lids on things before sending them to us. Pee that smells like raw fish that’s been left in the sun for a few days and leaking all over things is one thing (and apparently a daily thing). But when I pull out a bio bag where the bloody specimen is no longer in its leak-proof container because someone didn’t screw the lid on right (such as today), that is a problem.

And when the contents happen to be Products of Conception, AKA someone’s spontaneous abortion, AKA something we can never recollect, that is unacceptable.

Basal cell carcinoma, false colored section. Cells within the tumour are purple and have an abnormal arrangement. The skin surface is at top (red).

When I made my visit to a very good Mohs clinic in town (not as a patient), there was an elderly gentleman with a horn on his head. By which I mean he had a grey-black tumor the size of a very large egg on the top of his head which was actually shaped like a broken horn. He had spent years hiding it under a hat and had no family and friends to push him to see a doctor about it until that day.

When the doctor cut into it, the massive amount of necrotic tissue underneath stunk so badly, it knocked out the nurse in the room. It was… well, it was something else.

Uterine fibroid, H&E stain.

I try to avoid fresh tissues on this blog; it’s just a thing. In any case, for a lot of greenhorns (and not so greenhorns) in healthcare, the question of “how did the patient let it get so bad?” seems to come up a lot. Actually, I’m pretty sure this will never go away no matter how old I get, considering I don’t normally get the liberty of asking.

Case in point (one of many to come, I promise), not too long ago, I opened up a bucket in histo grossing and there was a fibroid sized just smaller than a basketball that was taken out of someone’s abdomen. 

Collagenous colitis in a section of large intestine, Masson’s Trichrome stain using aniline blue as the counter(/collagen) stain. 

Reed Sternberg cell in Hodgkin’s lymphoma.

You don’t see them in bone marrow aspirates very often (they are usually in the trephine biopsy).

A flame cell, a plasma cell variant that overproduces IgA antibodies. IgA antibodies are loaded with carbohydrates which stain red with a routine Wright’s stain.