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Megan @megothelioma.bsky.social · Aug 28

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

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Megan @megothelioma.bsky.social · Aug 28

"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

Megan @megothelioma.bsky.social · Aug 20

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

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Megan @megothelioma.bsky.social · Aug 13

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

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Megan @megothelioma.bsky.social · Aug 6

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

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Megan @megothelioma.bsky.social · Jul 30

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

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Megan @megothelioma.bsky.social · Jun 25

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

#pathsky #hemepath #hematopathology #hematology

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Megan @megothelioma.bsky.social · Jun 18

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

Megan @megothelioma.bsky.social · Jun 11

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

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Megan @megothelioma.bsky.social · Jun 4

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

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Megan @megothelioma.bsky.social · May 28

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

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Megan @megothelioma.bsky.social · May 21

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

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Megan @megothelioma.bsky.social · May 14

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

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Megan @megothelioma.bsky.social · May 7

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

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Megan @megothelioma.bsky.social · Apr 30

It is EBER in situ hybridization! This is an EBV+ mucocutaneous ulcer.

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Megan @megothelioma.bsky.social · Apr 30

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

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Megan @megothelioma.bsky.social · Apr 23

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

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Megan @megothelioma.bsky.social · Apr 16

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

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Megan @megothelioma.bsky.social · Apr 9

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

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Megan @megothelioma.bsky.social · Apr 2

Just based on morphology, any thoughts about what lymphoid process might be sneaking into this marrow? 🌠

#hematopathology #pathsky #hematology #pathresidents

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Megan @megothelioma.bsky.social · Mar 26

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

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Megan @megothelioma.bsky.social · Mar 19

🦌 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

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Megan @megothelioma.bsky.social · Mar 14

Melan-A is positive! It's a little melanocytic lesion. Mostly likely a capsular nevus.

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Megan @megothelioma.bsky.social · Mar 14

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

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Megan @megothelioma.bsky.social · Mar 5

Never seen such a beautiful bone marrow core in all my days 😍

#hematology #pathsky #pathology #hematopathology

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