Johns Hopkins Pathology
@JHUPath
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The Department of Pathology at Johns Hopkins University
Baltimore
Joined August 2010
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Last Seen Profiles
Our newest Appendiceal Pathology teaching app has launched! Designated to teach non-neoplastic and neoplastic pathology, with a focus of mucinous neoplasms
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A pediatric patient who was treated for Ewing sarcoma with chemotherapy now presents with a retroperitoneal node enlargement. What is your diagnosis? Answer and explanation to follow.
#pathology
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Congratulations to our incoming pathology interns! 🔬 welcome to Johns Hopkins!
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This case is an adult male who underwent a radical prostatectomy. What is the diagnosis?
A. Intraductal carcinoma of the prostate
B. Atypical intraductal proliferation
C. High grade prostatic intraepithelial neoplasia
D. Clear cell cribriform hyperplasia
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179
The Johns Hopkins Department of Pathology has developed a new, unique website to teach bone and soft tissue pathology. The website () is intended for residents, fellows and attending pathologists.
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Happy new year to all! Starting off with a great case:
An adult patient presents with a lip mass, shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
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An adult patient presents with a bladder mass, shown below. What is your diagnosis?
A. Nodular fasciitis
B. IgG4-related sclerosis
C. Solitary fibrous tumor
D. Inflammatory myofibroblastic tumor
E. Desmoid-type fibromatosis
F. Leiomyosarcoma
Answer and explanation to follow!
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45
137
A teenage patient presents with a mandible cyst, shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
#MedEd
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130
Check out this awesome pathology illustration about PASH and myofibroblastoma by medical student
@alex_tatarian
based on her experience rotating at Hopkins with breast pathologist Dr. Ashley Cimino-Mathews.
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Always a treat to see this tumor. A retroperitoneal mass in an elderly woman. What is an immunostain you would like to perform? (see vote)
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This is a case of an adult female who had an appendectomy. What is the diagnosis?
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An adult male presents with testicular mass. This is an orchiectomy specimen. What is your diagnosis? Answer and explanation to follow.
#Pathology
#GUpath
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Nodular cystic fat necrosis: a distinctive rare soft-tissue mass
A new article co-authored by
@JMcMahonG
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✨Congratulations to our incoming PGY-1s! ✨
Welcome to the Johns Hopkins Pathology family!🎉
#pathmatch2024
#pathology
#johnshopkins
#johnshopkinsmedicine
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A 65 year old man presents with a retroperitoneal mass. The tumor cells are positive for SF-1 and negative for PAX-8 on immunohistochemistry. What is the diagnosis?
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A 45 year old male presents with a spinal cord mass. The histology of the lesion is shown below. What is your diagnosis?
Answer and explanation to follow!
#Pathology
#Path
#MedEd
35
63
115
A 50 year old male presents with a testicular mass, shown below. What is your diagnosis?
A. Yolk sac tumor
B. Seminoma
C. Mesothelioma
D. Embryonal carcinoma
E. Metastatic adenocarcinoma
F. Sertoli cell tumor
Answer and explanation to follow!
#Pathology
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We are thrilled to announce the Johns Hopkins Pathology intern class of 2022-2023! Congratulations and we can't wait to have you join our family.
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An adult patient presents with a neck mass, shown below. What is your suspected diagnosis? Answer and explanation to follow!
#PathTwitter
#Pathology
#MedEd
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Happy holidays to all! Our gift to you is this exciting case:
An elderly patient presents with a skin rash, shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
#PathTwitter
#MedEd
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Mosaic Pattern as seen in Paget's Disease of the Bone.
#pathology
#path
#bone
#medicalschool
#medschool
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A male teenager presents with a parotid mass. The histology of the lesion is shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
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Happy May!
An adult female patient presents with small bowel obstruction. What is your diagnosis? Answer and explanation to follow!
#Pathology
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D. ALK. Inflammatory myofibroblastic tumor (IMT) stains positively for ALK in over 1/2 of cases. A negative ALK doesn't exclude it. IMT can be CK, desmin, and SMA positive. These stains are not helpful if the differential is with sarcomatoid carcinoma or a smooth muscle tumor.
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Here's the answer to yesterday's case. Thanks for the great comments!
E. PAX-8
Nephrogenic adenoma is a rare, benign mimicker of prostate adenocarcinoma that will be CK+ and may show staining for PSA. PAX-8 labels nephrogenic adenoma but not prostate adenocarcinoma
#pathology
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These images are from a young female with rectal bleeding. What is the diagnosis?
Leiomyosarcoma
Malignant gastrointestinal stromal tumor
Metastatic breast carcinoma
Primary anorectal melanoma
Sarcomatoid carcinoma
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Answer to the case of the week: Sclerosing Sertoli cell tumor. It is characterized by markedly sclerotic fibrous stroma containing cords, solid or hollow tubules, and nests of Sertoli cells. Immunostains show nuclear positivity for SF-1 and B-catenin. Thank you all for comments!
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An adult male suffers a fracture of the femoral head, and a mass is subsequently discovered and removed. Representative H&E images are shown. Which of the following stains would most likely confirm the identity of this lesion?
#PathTwitter
#PathMatch23
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Happy Friday! An adult patient presents with a cheek lesion. What is your diagnosis?
#pathology
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Answer to last wk's case: Uterine tumors resembling ovarian sex cord tumor (UTROSCT). UTROSCT is a mesenchymal uterine tumor consisting cells with architectural patterns resembling ovarian sex cord-stromal tumors without recognizable component of endometrial stromal neoplasia.
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A child undergoes nephrectomy for a solitary renal mass. Histologic examination demonstrates a blastemal predominant type Wilms tumor. Representative H&E images from the tumor and adjacent renal parenchyma are shown. What is the significance of the structures outlined in red?
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#WhiteCoatsForBlackLives
today at
@HopkinsMedicine
. We knelt down in solidarity for 10 minutes as we recited the names of victims of police brutality, followed by a moment of silence.
#path4blacklives
#blacklivesmatter
#pathology
#pathtwitter
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Our program was once again ranked as the
#1
pathology residency program by reputation on Doximity for 2021-2022. We are so proud of our excellent program and residents, and grateful for this recognition!
#PathMatch22
#Match2022
#PathTwitter
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A young man underwent radical orchiectomy for a 1.2 cm testicular mass. What is your diagnosis? Answer and explanation to follow.
#Pathology
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Happy 4th of July! Thank you everyone for following us. Here is a new case for a new academic year. An adult male presented with sinonasal mass. What is your diagnosis? Please vote in the comment.
#Pathology
Enjoy your holiday!
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Happy April!
An adult patient presents with a mediastinal mass. What is your diagnosis? Answer and explanation to follow!
#Pathology
#PathTwitter
#MedTwitter
#MedEd
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A middle aged male presents with a urethral mass. What is your diagnosis and what stains would you do to confirm it? Answer and explanation to follow.
#pathology
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An adult male presents with lower urinary tract symptoms of bladder outlet obstruction. The histology of the lesion on TURP specimen is shown below. What is your diagnosis? Answer and explanation to follow.
#Pathology
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An adult patient presents with a palate mass, shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
#MedEd
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A middle-aged man presents with sinusitis, and the lesion below is discovered. What is your diagnosis? Answer and explanation to follow!
#Pathology
#Path
#MedEd
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A middle-aged patient presents with a carotid body mass. Which immunostain would most likely be negative in all cells?
A. S100
B. Synaptophysin
C. Chromogranin
D. GATA3
E. Cytokeratin
F. CD56
Answer and explanation to be posted on Friday.
#path
#pathology
#medicine
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Answer to last case:
Blastic plasmacytoid dendritic cell neoplasm (BPDCN) – rare, aggressive neoplasm arising from precursors of plasmacytoid dendritic cells. Most patients present with cutaneous lesions, and can also have bone marrow involvement and leukemic dissemination.
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A young adult male presents with a testicular mass. The histology of the lesion is shown below. What is your diagnosis? Answer and explanation to follow!
#Pathology
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A 5 year old female presents with abdominal pain a mass on the pancreatic head. The mass is resected and demonstrates the following histology. Which is the most likely diagnosis?
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Happy holidays! What better way to celebrate the holidays than with a surgical pathology case?
An adult male patient presents with a left elbow lesion. What is your diagnosis? Answer and explanation to follow!
#Pathology
#Path
#MedEd
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Please welcome our incoming PGY1 class! We are so proud and excited to have you join our family. Can’t wait to meet you in person! ( with social distancing)
#PathMatch21
#Pathology
#MatchDay2021
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An older adult female with extensive smoking history undergoes a partial lobectomy for a lung mass. The tumor morphology is seen below. Which of the following is most likely true about this tumor?
#PathTwitter
#PathMatch23
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5/1 Case Answer: D, INI-1
Epithelioid sarcomas are rare tumors with high metastatic potential that often involve the distal extremities. They are typically positive for cytokeratins (AE1/AE3) and CD34 but negative for CD31. Loss of INI-1 labeling is characteristically seen.
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Come down to pathology for a chat! Learn the microscope's name.
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While you're social distancing, keep up your
#pathology
education with our posts!
Today's case: An elderly male presents with a pancreatic mass. His FNA is suspicious for adenocarcinoma. What is your diagnosis? Vote in the next tweet - answer and discussion to follow!
#MedEd
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Announcing our new chief residents for 2022-2023: Dr. Gabrielle Bailey and Dr. Harsimar Kaur!
Congratulations to both of them and we can’t wait to see the great things they’ll do as chiefs.
And a big thank you to our outgoing chiefs, Dr. Katelynn Davis and Dr. David Peske!
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An adult female presents with a kidney mass. What is your diagnosis and what are the most common mutations? Hint: the tumor cells stain positive for CK20. Answer and explanation to follow.
#Pathology
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C. Tubular adenoma with squamous morules
Squamous morules can be seen in colonic adenomas and can mimic invasive carcinoma, especially when arising in pseudoinvasive foci. Morules may be present as pseudocribriform or solid nests.
Thank you all,
#Pathology
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Answer: Hemangioblastoma
Hemangioblastoma is a rare, benign (WHO grade I), slow-growing tumor that primarily occurs in the CNS but may occasionally occur in other sites. It is composed of a capillary proliferation with foamy stromal cells.
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E. Paragangliomas (with the exception of those of the cauda equina) are typically negative for cytokeratins, useful in distinguishing this entity from carcinoid tumors. GATA3 positivity is found in a significant subset of paragangliomas and is a potential pitfall.
Thanks to all!
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A middle aged patient presents with a bladder tumor. Which positive immunostain would be most helpful to the diagnosis? Vote now in reply! Answer and explanation to be posted Friday. Thanks to
@Andres_Matoso
for his expertise!
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A middle-aged male presents with an inguinal mass. What is your diagnosis? Answers and explanation to follow! Vote now in the poll (our reply to this tweet)!
A. Angiomyofibroblastoma
B. Solitary fibrous tumor
C. Cellular angiofibroma
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The
@HopkinsMedicine
#pathology
residents recently had a beautiful department photo day in front of the infamous dome!
Congratulations to our current and graduating senior residents
@JHUpath
! 🎊👏🎉
#pathtwitter
#pathmatch24
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We are proud to announce the launch of our new website, "Clinical Pathology Unknowns" (), an interactive clinical pathology educational resource.
We hope you find these cases educational and enjoyable!
#Pathology
#PathTwitter
1
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Here's the answer for this week case.
C. Renal Medullary Carcinoma
Though originally included rhabdoid tumor of the kidney, Renal Medullary Carcinoma is a distinct entity. RMC affects young patients with sickle cell trait. Like rhabdoid tumor, RMC shows INI1 protein loss.
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A middle-aged woman who presents with anemia undergoes endoscopy and biopsy for a gastric polyp. Representative H&E images of the polyp are shown. Which of the following statements correctly describes this entity?
#PathTwitter
@Hopkins_GI_Path
#PathMatch23
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Happy New Year!🎉
Answer to last week's case: Myofibroma - benign pericytic neoplasm with biphasic pattern: less cellular myoid nodules + more cellular zones with hemangiopericytoma-like vessels. Most lesions are small & circumscribed. Myofibromatosis is the multicentric form.
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This a middle-aged woman with a cystic lesion in the tail of the pancreas. What is the diagnosis?
A.Intraductal papillary mucinous neoplasm
B.Mucinous cystic neoplasm
C.Serous cystadenoma
D.Retention cyst
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An adult female with uterine mass. What is your diagnosis? Answer and explanation to follow.
#Pathology
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An adult woman with hematuria undergoes a transurethral resection of a bladder mass. Representative H&E images are shown. Which of the following is the correct diagnosis?
#PathTwitter
#PathMatch23
#Path2Path
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Happy labor day weekend!
A 42 year old female presents with a right ankle mass. What is your diagnosis?
Answer and explanation to follow!
#Pathology
#SurgicalPathology
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Patient in his 40s with hx of a distal extremity lesion presents with new lung lesions. Atypical cells are AE1/AE3 and CD34 positive but CD31 negative. Which additional stain would be most helpful to dx?
A. GATA3
B. PAX8
C. S-100
D. INI-1
E. CA9
F. CD45
Answer later this week.
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A 35 year old female with a history of abdominal wall surgery presents with a 4 cm abdominal mass. Which of the following immunostains would you expect to be positive in this lesion?
A.) GATA3
B.) CK20
C.) CDX2
D.) CD10
(Vote in the next tweet!)
#pathology
#medtwitter
#MedEd
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Answer to last wk's case: sex cord stromal tumor with fibrothecomatous and sertoli components. The cytology seen in the tubules is identical to normal sertoli cells. The spindle cell component is similar to what is seen in fibrothecomatous lesions more commonly found in ovary.
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Prostate Cancer: Update on Grading and Reporting
Newly published in Surgical Pathology Clinics by Hopkins pathologists Drs. Baraban and Epstein.
1
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We have just released our 7th iPAD teaching app! The Johns Hopkins Atlas of Renal Transplant Pathology is designed to teach residents, fellows, and practicing pathologists the basic pathologic lesions in the kidney allograft.
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Pancreatoblastoma in an Elderly Woman: A Case Report Simulating a Pancreatic Neuroendocrine Tumor with Emphasis on Cytomorphologic Features
A new publication by Hopkins trainees and pathologists
@CarlaSaoud
@AnnieAWu
@ctisus
@RalphHruban
@sza_jhcyto
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Ans to case of the wk: Acinic Cell Carcinoma is a low grade carcinoma of serous cell differentiation, most commonly involves parotid gland. It can present as different patterns- solid, papillary-cystic, microcystic. The cells contain PAS(+), diastase resistant zymogen granules.
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B. Pulmonary alveolar proteinosis (PAP)
GMS is negative in this case. PAP is a non-neoplastic condition in which alveoli are filled with proteinaceous material. Normal alveolar architecture is preserved. The material is PAS+ and diastase resistant.
Thank you all.
#Pathology
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A 49 year old female presents with a lesion on the lateral border of the tongue. What is your diagnosis?
Answer and explanation to follow!
#Pathology
#MedEd
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A patient in his 70’s with a mildly elevated PSA undergoes a TURP for BPH. Which immunostain would be most helpful in establishing the diagnosis? Answer and explanation to be posted later this week.
#path
#pathology
#medschool
A. PSA
B. HMWCK
C. Racemase
D. P63
E. PAX-8
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Answer to this week's case:
D. Inflammatory myofibroblastic tumor
Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm of low malignant potential, composed of cytologically bland myofibroblastic spindle cells alongside inflammatory cells.
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23
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Answer to last week's case:
C. Adrenal cortical carcinoma
Adrenal cortical carcinoma (ACC) is an uncommon malignant epithelial neoplasm arising from cells of the adrenal cortex. Age distribution is bimodal, with greatest incidence in young children and adults in their 5th decade.
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At Johns Hopkins Pathology, we cherish and promote diversity among our faculty, staff, residents and fellows. We are sickened by the senseless murder of George Floyd, and we would like to express our utmost solidarity in standing against racism and inequity. (1/3)
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52
Answer to this week's case:
C. EBV In Situ Hybridization
Epstein-Barr Virus-Associated Smooth Muscle Tumor (BVSMT) presents in immunocompromised patients and stains positive for smooth muscle markers and EBV.
Thank you for the great comments!
#pathology
#path
0
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Inverted sinonasal papilloma.
Sinonasal papillomas are benign epithelial neoplasms arising from sinonasal mucosa and usually present in pts 30-60 y/o, more often male. There are inverted, exophytic & oncocytic types. They may uncommonly undergo malignant transformation.
#Pathology
0
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Congratulations to Hopkins pathologist and breast pathology expert Dr. Ashley Cimino-Mathews for being selected as one of Baltimore Magazine's 2022 Top Doctors.
2
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Despite COVID 19, our social medial is still up and running! A middle-aged man is found to have a bladder lesion and undergoes biopsy. What is your diagnosis? Answer and explanation to follow.
#Pathology
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Answer: Rosai-Dorfman Disease (RDD). RDD presents with lymphadenopathy, often cervical. The sinuses are dilated and filled with characteristic S100+ histiocytes that have abundant eosinophilic cytoplasm and show emperipolesis, i.e. engulfment of other cells.
#Pathology
#MedEd
0
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Answer to last wk's case: Glomus tumor (GT). It is a benign tumor usually seen in young adults with a predilection for the distal extremities, particularly under the nail bed (subungual) but can have a wide distribution. It presents as a painful lesion and usually small.
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A middle-aged woman with a history of uterine cancer undergoes resection of a brain tumor. H&E images are shown. Which of the following statements regarding this neoplasm is correct?
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Answer: Subgemmal neurogenous plaque (SNP). These are normal neural structures associated w/ taste buds & are found on the posterior third of the lateral border of the tongue. SNPs can become inflamed/prominent & present as a lesion on the tongue.
Thank you all!
#Pathology
#MedEd
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Answer: Pleomorphic hyalinizing angiectatic tumor (PHAT) arising from hemosiderotic fibrolipomatous tumor (HFLT). Both tumors have TGFBR3-MGEA5 gene fusion. Peripheral areas of PHAT can be identical to HFLT.
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An 80 year old woman requires surgical resection of an infiltrative submandibular mass.
#Pathtwitter
#Pathmatch23
#Path2Path
2
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A 46 year old female with abnormal uterine bleeding presents with an enlarging inguinal mass.
#pathology
#path
1
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Positive GPNMB Immunostaining Differentiates Renal Cell Carcinoma With Fibromyomatous Stroma Associated With TSC1/2/MTOR Alterations From Others
0
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Necrotizing pneumonia due to Herpes Simplex Virus. Special thanks to
@DebbieBelchis
for photos and preparation.
1
28
46
Answer: Low-grade mucoepidermoid carcinoma (MEC).
MEC is a malignant salivary gland tumor with 3 distinct cell types: epidermoid cells, mucous cells & intermediate cells. Criteria that increase tumor grade include anaplasia, necrosis, inc. mitoses, PNI & solid pattern.
#Pathology
0
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Thank you to our 10,000 followers! Please continue following along for the latest in pathology research, education, and news.
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C. Cellular angiofibroma: a benign tumor that can occur in the genital tract of both males & females. It is composed of bland spindled lesional cells, and often contains prominent blood vessels with hyalinized walls. These tumors stain positive for CD34.
Thank you all!
#pathology
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