Teenager with nephrotic syndrome. Biopsy revealed unusual case of membranous nephropathy in a peds patient. PLA2R positive (IHC). PLA2R most common antigen in peds MN. EXT2 also common, SEMA3B less common. (pubmed.ncbi.nlm.nih.gov/3802…) #renalpath#pathsky#nephsky
✅#1 & Bonus Answer: Endocervical Adenocarcinoma in situ (AIS)
cells in strips & rosettes
nuclear feathering pseudostratification
chromatin is coarse, evenly distributed
nucleoli variably present
cytoplasm diminished, finely vacuolated, with unclear borders
background clean, but inflammatory debris may be present
liquid base prep features
- may show “bird tail” arrangement of pseudostratified strips of cells
- feathering, rosettes, and strips are more subtle
- nucleoli more readily visible
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✅#2 Answer: HSIL extending into glands
clues to a squamous origin include central spindling or whorling with flattening of the nuclei at the periphery
Other HSIL features:
cells occur singly, in sheets, or syncytial aggregates
nuclear enlargement varies, but N:C is always high
nucleoli generally absent
cytoplasm can be immature, mature (keratinizing), or metaplastic
liquid base prep
- more often see dispersed single cells
- less hyperchromasia
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✅#1 & #3: *ABUNDANT* colloid is considered benign and satisfactory for evaluation, even if the “6 groups of 10” criterion of adequacy is not met.
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✅#2: Excessive gel and precipitated stains may obstruct cellular features, rendering an aspirate non-diagnostic.
A complete lack of follicular cells in the absence of colloid (e.g., blood or cyst fluid only) is another reason for the non-diagnostic category
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Answer for #1 and Bonus: Tubal metaplasia
Cells: columnar, ciliated (with terminal bar), pseudostratied or in small groups
Nuclei: round to oval, may be pleomorphic or hyperchromatic, chromatin evenly distributed, nucleoli not seen
Cytoplasm: discrete vacuoles and goblet cell change
!!! Individual ciliated cells is not enough !!!
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Answer for #2: Atypical endocervical cells
Cells: sheets, strips, pseudostratified
Nuclei: enlarged, elongated, hyperchromatic with heterogeneous & coarse chromatin
Hyperchromasia that is more monotonous than simple metaplasia
Cytoplasm: may be abundant, but N:C is increased; distinct cell borders
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