Descriptive Techniques in Pathology II:

Microscopic Descriptive Techniques

Paola Roccabianca

1)
MICROSCOPIC DESCRIPTION of TUMORS

The microscopic description of a neoplastic lesion is well standardized.

EVALUATION OF THE LESION

Regardless of the process, the first few seconds should be spent evaluating the slide
sub-grossly. This simple inspection provides with an enormous amount of information
and may save time. If the lesion is neoplastic you can evaluate:

 Exophitic growth (papilloma)

 Endophitic growth (inverted papilloma, “infundibular
keratinising achantoma”)
 Shape (dome shaped  histiocytoma)
 Has a pore (infundibular keratinizing achantoma)
 Extension (well demarcated or extending to cut borders)
 Focal or multifocal
 Colour : black (melanoma), intensely blue (lymphoma)
 Else?

All the features above are important and most of them need to be included in the
microscopic description.

Example:

Anatomic location, size, shape, cut borders, demarcation can be evaluated as well as the
most likely tumour type. This is a dermal, 1,5 cm nodule that seems well demarcated and
intensely pigmented.
THE WRITING PROCESS

Part A. The first part of the description is very important (several points!!!) and
summarizes the “low power” magnification. This represents the 20/25X. This sentence
tells to the reader that you know is a tumour and that is probably either benign or
malignant.
In the sentence the following data (when applicable) should be included:

 Anatomic location Epidermal, dermal (superficial, mid, deep), dermis

extending into the panniculus
 Size

 Shape

Shape Tumor type (some examples)

Dome shaped Histiocytoma
Nodular Lymphoma
Plasmaytoma
Multinodular Trichoepitelioma
Cutaneous hystiocytosis
Multilobulated Haemangiopericytoma
Basal cell tumour
Trichoblastoma
Multilocular Haemangioma (cavernous)
Multilocular cytstic Apocrine gland cytstadenoma/carcinoma
Verrucous Fibropapilloma
Bowen’s disease

 Growth Exophytic (papilloma)

Endophytic (inverted papilloma, infundibular keratinizing
achantoma)
Expansile
Infiltrative
Epitheliotrophic (Mycosis fungoides)

 Cellularity Densely cellular (basal cell carcinoma, lymphoma)

Sparsely cellular (myxoma)

 Demarcation Well demarcated

Poorly demarcated
Blending into the normal tissue

 Capsule Encapsulated
Unencapsulated
Incomplete capsule
Indicate if the capsule is invaded by the tumour!

 Margins/Cut Borders of the Section

 Extending/Not extending to the cut borders (one or more)

Example:

Dog, haired skin

Dermal 1x1,5 cm, expansile nodule, well demarcated, unencapsulated, densely cellular, heavily
pigmented. The lesion does not extend to the cut borders.

Part B. GROWTH PATTERN and STROMA: the growth pattern and the stroma
are the next information to be included in the description. These data are important to
inform the reader that you have focused the histogenesis/embryogenesis of the tumour.
This part of the description represents the 100X magnification.

 Epithelial Growth patterns

Pattern Examples
Cords Trichoblastoma, Squamous cell
carcinoma
Islands Squamous cell carcinomas, hepatoid
gland adenomas
Lobules Adnexal tumours, Basal cell tumor,
Adenomas
Papillary/Papillomatousmatous Papilloma
Pockets Merkel cell tumor
Ribbons Trichoblastoma

 Glandular growth patterns

Acini
Lobules
Papillary fronds (sweat gland tumours)
Tubules

 Mesenchymal growth patterns

Bundles (cells arranged tightly, in variable
directions eg. Interlacing bundles,
interwoven bundles)
Streams (cells arranged in the same direction)

Whorls (cells circumscribing a central area)

 Storiform (arranged radially around a central

area)
 ««« Herringbone (bilaterally radiating from the centre)
 Round cell growth patterns

Sheets (densely cellular, no orientation, poor

stroma)
Nests plasmacytoma, melanoma

 Epitheliotropism melanocytoma
junctional and compound melanoma
Mycosis fungoides
Histiocytoma

 Mixed growth pattern

the general rule is NOT to use mixed patterns
since the reader is confused feeling you have not
decided what is the origin of the neoplasm.
However, there are EXCEPTIONS to this rule:

1) Lobules+bundles complex apocrine gland npl

2) Bundles+nests+sheets (melanomas)

STROMA
Amount minimal, moderate, abundant, variable, stalk
Type fibrous, fibrovascular, hyalinized, myxoid

(if fibrous reaction is caused by the tumour call it with it’s name: desmoplasia!)

This is the first sentence where your knowledge of tumors shows!

You need to use the specific terms that characterize a tumor growth pattern
Such as Antoni A/Antoni B areas in Schwannoma

By the time this part has been written we also know that the tumour is epithelial or
mesenchymal

Example:

The nodule is composed of densely packed interlacing bundles and whorls of cells embedded in a
minimal amount of fibrous stroma.
 Part C. DESCRIPTION OF THE CELL
There is no need to be a good cytologist, just remember the cellular components that need
to be evaluated and do not forget any of the list. This is the sentence that represents the
high power.

 Cell Size diameter in microns

 Shape Round
Spindle (fusiform)
Polygonal, cubical, columnar, polyhedral

 Margins/borders
Distinct/Indistinct

 Cytoplasm
Colour
Texture: homogeneous, fibrillar, striated etc.
Content: pigment, granules, vacuoles

 Nucleus Shape (round, oval, irregular, indented etc.)

Location (central, paracentral, eccentric etc.)
Chromatin (diffuse, reticular, granular, marginated)

 Nucleolus Number, shape, colour, size, +/- evident

 Mitotic figures Average number/range

Morphology (typical/atypical)

Example:

Cell features are often obscured by abundant dark brown to black granular cytoplasmic pigment
(melanin). Multifocally, there is a reduction of cytoplasmic pigment and cytological features are
evident. In these areas cells are large, spindle shaped with indistinct cell borders and a moderate
amount of clear, finely pigmented cytoplasm. Nuclei are oval to irregular with diffuse to finely
clumped chromatin. One to two nucleoli are present. Mitotic figures range from 0 to 1 per HPF and
are occasionally atypical.
 Part D. SPECIAL FEATURES of THE TUMOUR
In this part is very important the knowledge of the different tumour histotypes. Here
enclosed are some examples of the specific terms that may identify or characterize a
given tumour and that need to be described and named.

Epithelial Tumours

Apocrine gland tumours Ceroidophages

Epitheliotropic lymphoma Pautrier’s microabscesses
Pilomatrical tumours Ghost cells
Squamous cell carcinoma Keratin/Horn pearls, dyskeratosis, non
degenerated neutrophils
Viral papillomas Koilocytes, large keratohyaline granules

Mesenchymal Tumours

Chordoma Physalipherous cells

Lymphoma Tingible body macrophages/Flemming cells
(rare in the skin)
Plasmocytoma Russel bodies (Mott cells)
Rhabomyosarcoma Strap cells
Schwannoma Verocay bodies

Example:

Multifocally, large cells with coarsely clumped melanin granules of irregular size and shape are
present (melanophages). No junctional activity is present.

Part E. ATYPICAL FEATURES

 Pleomorphysm of cells/nuclei (anysocytosis,

anysokaryosis)
 Giant cells (give the size)
 Multinucleated cells
 Apoptotic cells
 Necrosis
 Vascular emboli
 Hemorrhage

Example: Occasional binucleated atypical cells were observed. (Vascular neoplastic emboli were
not present, do not write what is not there! But remember to look for it!)
Part F. ADDITIONAL LESIONS
Don’t forget to look at all the slide after you have written the main description. There might
be “additional” lesions to be described such as epidermal/adnexal lesions.

Example:

Adnexal structures are displaced at the periphery with the exception of few sebaceous glands and
follicles entrapped in the neoplasm. Follicular keratosis and dilation of sweat glands are
occasionally present. The epidermis overlying the mass is mildly achantotic and perivascular
accumulation of small, mature lymphocytes can be seen.

Part G. MORPHOLOGIC DIAGNOSIS

It is the diagnosis of the tumour and includes the tissue (more specific as possible), tumour
name and type, malignancy (if applicable)

Example:

MD: Haired skin: dermal melanocytoma, spindle cell type

Part H. ADDITIONAL QUESTIONS

Cell of origin (Langherhnas cell for hystiocytoma)
Immunohistochemical specific markers
Etiology (Papillomavirus, UV-light, Hamster papovavirus etc.)

SCORE of the Histologic Description

Points
Design/Style 2 points
Tissue Recognition 1 point
Description of the 13 points (divided by
lesion key words)
MD 4 points
Total 20 points
Passing score 12 points
2) MICROSCOPIC DESCRIPTION of INFLAMMATORY LESIONS

The microscopic description of inflammatory or degenerative lesions is less well

standardized compared to neoplasia.

Part A. The first part of the description is very important (several points!!!) and is
considered the “subgross description” of the lesion. It is composed of several elements
In the sentence the following data (when applicable) should be included:

 Organ, specific microanatomic location in the organ

 Amount of organ invoveld/effacement (identifies severity)

Part B. identification of the elements involved.

Generally from the most important to the less important features.
Otherwise not to foget any component describe the organ with a specific order.
Describe and interpet

 Amount of organ involved/effacement (identifies severity):

Example: The interstitium of 70 % of the lung section is severely expanded by….

 Cell types in order of more to less represented

Example: the inflammation is characterized by a central core composed of a

majority of reactive foamy macrophages surrounded by small mature lymphocytes and
plasmacells and lesser numbers of plump fibroblasts (granuloma)

 Non cellular components: quantify, identify site (cytoplasmic, int he wall of the vessel
etc), amount.

 necrosis
 mucin
 edema
 hemorrhage
 fibrin
 amyloid….

Part C. identification of the Causative agent (if present)

 Location
 Shape and size (specific terms)
 Inclusion bodies
 Describe and give the interpretation
Example: Multifocally surrounding and colonizing hair shafts elevated numbers of round, 3
micron in diameter, lightly basophilic stuctures (artrospores) and wavy, elongated,
unstained toi poorly stained refractile, segmented structures (fungal hyphae,
dermatophytes) are present.

Part D. any additional or minor finding in the tissue.

Part G. MORPHOLOGIC DIAGNOSIS

It is the summary of the description

 Organ: precise location

 Severity: minimal, mild, moderate, severe
 Timing: hyperacute, acute, sub.acute, chronic, chronic-active
 Distribution: focal, multifocal, locally extensive, diffuse
 Type: type of inflamamtion, degeneration etc

Example: severe, locally extensive, chronic, granulomatous penumonia with intralesional

yeasts