Pathology
Topics
FSD - PRE-COURSE KNOWLEDGE.................................................................................................. 6
BREAST ...................................................................................................................................... 11
BREAST NODULES ................................................................................................................................... 12
BENIGN EPITHELIAL LESIONS ..................................................................................................................... 13
Non-proliferative breast changes (fibrocystic changes) ............................................................ 13
Proliferative breast diseases without atypia ............................................................................ 14
Proliferative breast diseases with atypia ..................................................................................... 16
BENIGN STROMAL LESIONS ....................................................................................................................... 16
Fibroadenoma..................................................................................................................... 16
Phyllodes tumor .................................................................................................................. 17
BREAST CANCER ..................................................................................................................................... 17
CARCINOMA IN SITU ................................................................................................................................ 19
Ductal adenocarcinoma in situ.............................................................................................. 19
Lobular adenocarcinoma in situ ............................................................................................ 20
INVASIVE BREAST CANCER ......................................................................................................................... 21
Ductal adenocarcinoma ....................................................................................................... 21
Lobular adenocarcinoma ..................................................................................................... 21
Tubular adenocarcinoma ...................................................................................................... 21
Medullary adenocarcinoma .................................................................................................. 22
Mucinous (colloid) adenocarcinoma ...................................................................................... 22
MALE BREAST CANCER ............................................................................................................................. 24
GYNECOMASTIA ...................................................................................................................................... 25
PAGET DISEASE OF THE NIPPLE ................................................................................................................... 25
PROSTATE PATHOLOGY ............................................................................................................... 26
BENIGN PROSTATIC HYPERPLASIA (NOT IN SYLLABUS)..................................................................................... 27
PROSTATE CANCER .................................................................................................................................. 28
CERVICAL PATHOLOGY ............................................................................................................... 34
CERVICAL CANCER PRECURSOR LESIONS ..................................................................................................... 35
SQUAMOUS CERVICAL CARCINOMA............................................................................................................ 38
ADENOCARCINOMA ................................................................................................................................. 39
CNS PATHOLOGY ....................................................................................................................... 41
GLIOMAS .............................................................................................................................................. 42
Astrocytoma ....................................................................................................................... 42
Glioblastoma ...................................................................................................................... 44
Oligodendroglioma, 1p/19q co-deleted (grade 2 or 3) ............................................................... 45
MENINGEAL TUMORS ............................................................................................................................... 46
BRAIN METASTASES.................................................................................................................................. 48
Medulloblastoma ................................................................................................................ 48
NEURODEGENERATIVE DISEASES ................................................................................................................ 49
Parkinson’s disease ............................................................................................................. 50
1
, Alzheimer’s disease ............................................................................................................. 51
VASCULAR DISEASES OF THE CNS .............................................................................................................. 53
INTRACRANIAL HEMORRHAGE .................................................................................................................... 55
Intraparenchymal hemorrhage .............................................................................................. 55
Extradural hemorrhage ......................................................................................................... 56
Subdural hemorrhage .......................................................................................................... 56
Subarachnoid hemorrhage ................................................................................................... 57
SOFT TISSUE TUMORS ................................................................................................................ 61
LIPOMAS ............................................................................................................................................... 63
LIPOSARCOMAS ...................................................................................................................................... 64
TENOSYNOVIAL GIANT CELL TUMOR ........................................................................................................... 65
DEEP BENIGN FIBROUS HISTIOCYTOMA ........................................................................................................ 65
DERMATOFIBROSARCOMA PROTUBERANS ..................................................................................................... 66
PERIPHERAL NERVE SHEATH TUMORS .......................................................................................................... 66
Schwannomas .................................................................................................................... 66
Neurofibromas .................................................................................................................... 67
FIBROUS TUMORS ................................................................................................................................... 69
Nodular fasciitis .................................................................................................................. 69
Fibromatoses ...................................................................................................................... 69
INFANTILE OR CONGENITAL FIBROSARCOMA .................................................................................................. 69
SMOOTH MUSCLE TUMORS........................................................................................................................ 70
Leiomyoma ......................................................................................................................... 70
Leiomyosarcoma ................................................................................................................. 70
SKELETAL MUSCLE TUMORS ....................................................................................................................... 71
Rhabdomyosarcoma............................................................................................................ 71
GISTs – Gastrointestinal stromal tumors ................................................................................. 72
SOFT TISSUE TUMORS OF UNCERTAIN ORIGIN ................................................................................................ 74
Synovial sarcoma ................................................................................................................ 74
BONE TUMORS ........................................................................................................................... 76
PRIMARY BONE TUMORS ........................................................................................................................... 77
OSTEOGENIC TUMORS ............................................................................................................................. 78
Osteoid osteoma and Osteoblastoma .................................................................................... 78
Osteosarcoma .................................................................................................................... 79
CHONDROGENIC TUMORS ........................................................................................................................ 80
Osteochondroma ................................................................................................................ 80
Chondroma ........................................................................................................................ 81
Chondrosarcoma ................................................................................................................ 81
UNDIFFERENTIATED SMALL ROUND CELL SARCOMAS ....................................................................................... 82
Ewing sarcoma .................................................................................................................... 82
OSTEOCLASTIC GIANT CELL-RICH TUMORS ................................................................................................... 83
Giant cell tumor of the bone .................................................................................................. 83
SECONDARY BONE TUMORS ...................................................................................................................... 84
LUNG CANCER ........................................................................................................................... 87
ADENOCARCINOMA ................................................................................................................................. 88
SQUAMOUS CELL CARCINOMA ................................................................................................................... 88
SMALL CELL LUNG CANCER ....................................................................................................................... 89
2
, LARGE CELL LUNG CANCER ....................................................................................................................... 89
MOLECULAR CHARACTERIZATION OF LUNG CANCER ....................................................................................... 90
COLORECTAL CANCER ............................................................................................................... 92
MYELOID PATHOLOGY .............................................................................................................. 101
RASopathies ..................................................................................................................... 108
MYELOID NEOPLASMS ............................................................................................................................ 111
MYELODYSPLASTIC SYNDROMES .............................................................................................................. 112
ACUTE MYELOID LEUKEMIA ...................................................................................................................... 114
MYELOPROLIFERATIVE NEOPLASMS ........................................................................................................... 116
Chronic myeloid leukemia .................................................................................................. 118
Polycythemia vera ............................................................................................................. 119
ESSENTIAL THROMBOCYTHEMIA ............................................................................................................... 119
Primary myelofibrosis......................................................................................................... 120
MASTOCYTOSIS .................................................................................................................................... 121
Histiocytosis ..................................................................................................................... 122
LYMPHOID PATHOLOGY ............................................................................................................ 125
LYMPHOID NEOPLASMS .......................................................................................................................... 130
1. PRECURSOR B CELL NEOPLASMS ..................................................................................................... 134
Acute B cell lymphoblastic leukemia or lymphoma (B-ALL) ..................................................... 134
2. PERIPHERAL B CELL NEOPLASMS (MATURE B CELLS) ............................................................................ 134
Chronic lymphocytic leukemia or small lymphocytic leukemia ............................................... 134
Mantle cell lymphoma ........................................................................................................ 135
Follicular lymphoma .......................................................................................................... 136
Diffuse Large B-cell lymphoma (DLBCL) ............................................................................... 136
BURKITT LYMPHOMA .............................................................................................................................. 138
3. PRECURSOR T CELL NEOPLASMS ..................................................................................................... 138
Acute T cell lymphoblastic leukemia or lymphoma (T-ALL) ...................................................... 138
4. PERIPHERAL T CELL AND NK CELL NEOPLASMS ................................................................................... 139
Peripheral T cell lymphoma................................................................................................. 140
Anaplastic Large-Cell lymphoma ......................................................................................... 140
Adult T cell leukemia/lymphoma ......................................................................................... 141
Mycosis Fungoides/Sezary syndrome ................................................................................... 141
Large granular lymphocytic leukemia ................................................................................... 142
Extra-nodal NK/T cell lymphoma ......................................................................................... 142
ENTEROPATHY-ASSOCIATED TCL.............................................................................................................. 142
- Nodular sclerosis ...................................................................................................... 146
- Mixed cellularity ........................................................................................................ 146
- Lymphocyte rich ........................................................................................................ 147
- Lymphocyte depletion ................................................................................................ 147
- Lymphocyte predominant ........................................................................................... 147
Splenic B cell lymphomas .................................................................................................. 148
Hairy-cell leukemia ............................................................................................................ 149
Plasma cell neoplasms ...................................................................................................... 150
SKIN PATHOLOGY ..................................................................................................................... 151
BULLOUS LESIONS OF THE SKIN (NOT ASKED AT THE EXAM) ............................................................................. 154
NON-MELANOCYTIC PIGMENTED SKIN DISORDERS ....................................................................................... 156
3
, EPHELIDS (FRECKLES) ............................................................................................................................ 156
LENTIGO ............................................................................................................................................. 157
MELANOCYTIC LESIONS OF THE SKIN ......................................................................................................... 157
Melanocytic nevi: .............................................................................................................. 157
Dysplastic nevi: ................................................................................................................. 158
Blue nevus ........................................................................................................................ 159
Spitz nevus ....................................................................................................................... 160
Reed nevus ....................................................................................................................... 161
MELANOMA ......................................................................................................................................... 161
Superficial spreading melanoma ......................................................................................... 169
Nodular melanoma ............................................................................................................ 169
Lentigo maligna melanoma ................................................................................................. 169
Acral-Lentiginous Melanoma .............................................................................................. 170
Uveal melanoma ............................................................................................................... 170
Extracutaneous melanoma ................................................................................................. 171
KERATOCYTIC/EPITHELIAL TUMORS ........................................................................................................... 174
Seborrheic keratosis .......................................................................................................... 174
Actinic keratosis ................................................................................................................ 175
Bowen disease .................................................................................................................. 177
Squamous cell carcinoma .................................................................................................. 178
Keratoacanthoma .............................................................................................................. 180
Basal cell carcinoma ......................................................................................................... 180
Merkel cell carcinoma ........................................................................................................ 182
MESENCHYMAL TUMORS ........................................................................................................................ 183
Dermatofibroma (fibrous histiocytoma) ................................................................................ 183
Kaposi Sarcoma ................................................................................................................ 183
ENDOMETRIAL PATHOLOGY ...................................................................................................... 186
CHRONIC ENDOMETRITIS ........................................................................................................................ 186
ENDOMETRIOSIS AND ADENOMYOSIS ........................................................................................................ 186
ENDOMETRIAL POLYPS ........................................................................................................................... 189
Endometrial hyperplasia..................................................................................................... 190
ENDOMETRIAL CARCINOMA ..................................................................................................................... 190
Endometrioid carcinoma .................................................................................................... 191
Serous carcinoma (type 2) .................................................................................................. 192
MALIGNANT MIXED MULLERIAN TUMOR...................................................................................................... 194
ENDOMETRIAL STROMAL TUMORS ............................................................................................................. 195
OVARIAN PATHOLOGY .............................................................................................................. 197
PCOS ................................................................................................................................................ 197
OVARIAN TUMORS ................................................................................................................................. 198
Surface epithelial cell tumors .............................................................................................. 199
GERM CELL TUMORS .............................................................................................................................. 205
Dysgerminoma (not in syllabus) ........................................................................................... 206
Embryonal carcinoma (not in syllabus) ................................................................................. 206
Sex cord-stromal cell tumors .............................................................................................. 208
Metastases to ovaries ........................................................................................................ 209
KRUKENBERG TUMOR............................................................................................................................. 210
INTRAOPERATORY EXAMINATION .............................................................................................. 212
4
Topics
FSD - PRE-COURSE KNOWLEDGE.................................................................................................. 6
BREAST ...................................................................................................................................... 11
BREAST NODULES ................................................................................................................................... 12
BENIGN EPITHELIAL LESIONS ..................................................................................................................... 13
Non-proliferative breast changes (fibrocystic changes) ............................................................ 13
Proliferative breast diseases without atypia ............................................................................ 14
Proliferative breast diseases with atypia ..................................................................................... 16
BENIGN STROMAL LESIONS ....................................................................................................................... 16
Fibroadenoma..................................................................................................................... 16
Phyllodes tumor .................................................................................................................. 17
BREAST CANCER ..................................................................................................................................... 17
CARCINOMA IN SITU ................................................................................................................................ 19
Ductal adenocarcinoma in situ.............................................................................................. 19
Lobular adenocarcinoma in situ ............................................................................................ 20
INVASIVE BREAST CANCER ......................................................................................................................... 21
Ductal adenocarcinoma ....................................................................................................... 21
Lobular adenocarcinoma ..................................................................................................... 21
Tubular adenocarcinoma ...................................................................................................... 21
Medullary adenocarcinoma .................................................................................................. 22
Mucinous (colloid) adenocarcinoma ...................................................................................... 22
MALE BREAST CANCER ............................................................................................................................. 24
GYNECOMASTIA ...................................................................................................................................... 25
PAGET DISEASE OF THE NIPPLE ................................................................................................................... 25
PROSTATE PATHOLOGY ............................................................................................................... 26
BENIGN PROSTATIC HYPERPLASIA (NOT IN SYLLABUS)..................................................................................... 27
PROSTATE CANCER .................................................................................................................................. 28
CERVICAL PATHOLOGY ............................................................................................................... 34
CERVICAL CANCER PRECURSOR LESIONS ..................................................................................................... 35
SQUAMOUS CERVICAL CARCINOMA............................................................................................................ 38
ADENOCARCINOMA ................................................................................................................................. 39
CNS PATHOLOGY ....................................................................................................................... 41
GLIOMAS .............................................................................................................................................. 42
Astrocytoma ....................................................................................................................... 42
Glioblastoma ...................................................................................................................... 44
Oligodendroglioma, 1p/19q co-deleted (grade 2 or 3) ............................................................... 45
MENINGEAL TUMORS ............................................................................................................................... 46
BRAIN METASTASES.................................................................................................................................. 48
Medulloblastoma ................................................................................................................ 48
NEURODEGENERATIVE DISEASES ................................................................................................................ 49
Parkinson’s disease ............................................................................................................. 50
1
, Alzheimer’s disease ............................................................................................................. 51
VASCULAR DISEASES OF THE CNS .............................................................................................................. 53
INTRACRANIAL HEMORRHAGE .................................................................................................................... 55
Intraparenchymal hemorrhage .............................................................................................. 55
Extradural hemorrhage ......................................................................................................... 56
Subdural hemorrhage .......................................................................................................... 56
Subarachnoid hemorrhage ................................................................................................... 57
SOFT TISSUE TUMORS ................................................................................................................ 61
LIPOMAS ............................................................................................................................................... 63
LIPOSARCOMAS ...................................................................................................................................... 64
TENOSYNOVIAL GIANT CELL TUMOR ........................................................................................................... 65
DEEP BENIGN FIBROUS HISTIOCYTOMA ........................................................................................................ 65
DERMATOFIBROSARCOMA PROTUBERANS ..................................................................................................... 66
PERIPHERAL NERVE SHEATH TUMORS .......................................................................................................... 66
Schwannomas .................................................................................................................... 66
Neurofibromas .................................................................................................................... 67
FIBROUS TUMORS ................................................................................................................................... 69
Nodular fasciitis .................................................................................................................. 69
Fibromatoses ...................................................................................................................... 69
INFANTILE OR CONGENITAL FIBROSARCOMA .................................................................................................. 69
SMOOTH MUSCLE TUMORS........................................................................................................................ 70
Leiomyoma ......................................................................................................................... 70
Leiomyosarcoma ................................................................................................................. 70
SKELETAL MUSCLE TUMORS ....................................................................................................................... 71
Rhabdomyosarcoma............................................................................................................ 71
GISTs – Gastrointestinal stromal tumors ................................................................................. 72
SOFT TISSUE TUMORS OF UNCERTAIN ORIGIN ................................................................................................ 74
Synovial sarcoma ................................................................................................................ 74
BONE TUMORS ........................................................................................................................... 76
PRIMARY BONE TUMORS ........................................................................................................................... 77
OSTEOGENIC TUMORS ............................................................................................................................. 78
Osteoid osteoma and Osteoblastoma .................................................................................... 78
Osteosarcoma .................................................................................................................... 79
CHONDROGENIC TUMORS ........................................................................................................................ 80
Osteochondroma ................................................................................................................ 80
Chondroma ........................................................................................................................ 81
Chondrosarcoma ................................................................................................................ 81
UNDIFFERENTIATED SMALL ROUND CELL SARCOMAS ....................................................................................... 82
Ewing sarcoma .................................................................................................................... 82
OSTEOCLASTIC GIANT CELL-RICH TUMORS ................................................................................................... 83
Giant cell tumor of the bone .................................................................................................. 83
SECONDARY BONE TUMORS ...................................................................................................................... 84
LUNG CANCER ........................................................................................................................... 87
ADENOCARCINOMA ................................................................................................................................. 88
SQUAMOUS CELL CARCINOMA ................................................................................................................... 88
SMALL CELL LUNG CANCER ....................................................................................................................... 89
2
, LARGE CELL LUNG CANCER ....................................................................................................................... 89
MOLECULAR CHARACTERIZATION OF LUNG CANCER ....................................................................................... 90
COLORECTAL CANCER ............................................................................................................... 92
MYELOID PATHOLOGY .............................................................................................................. 101
RASopathies ..................................................................................................................... 108
MYELOID NEOPLASMS ............................................................................................................................ 111
MYELODYSPLASTIC SYNDROMES .............................................................................................................. 112
ACUTE MYELOID LEUKEMIA ...................................................................................................................... 114
MYELOPROLIFERATIVE NEOPLASMS ........................................................................................................... 116
Chronic myeloid leukemia .................................................................................................. 118
Polycythemia vera ............................................................................................................. 119
ESSENTIAL THROMBOCYTHEMIA ............................................................................................................... 119
Primary myelofibrosis......................................................................................................... 120
MASTOCYTOSIS .................................................................................................................................... 121
Histiocytosis ..................................................................................................................... 122
LYMPHOID PATHOLOGY ............................................................................................................ 125
LYMPHOID NEOPLASMS .......................................................................................................................... 130
1. PRECURSOR B CELL NEOPLASMS ..................................................................................................... 134
Acute B cell lymphoblastic leukemia or lymphoma (B-ALL) ..................................................... 134
2. PERIPHERAL B CELL NEOPLASMS (MATURE B CELLS) ............................................................................ 134
Chronic lymphocytic leukemia or small lymphocytic leukemia ............................................... 134
Mantle cell lymphoma ........................................................................................................ 135
Follicular lymphoma .......................................................................................................... 136
Diffuse Large B-cell lymphoma (DLBCL) ............................................................................... 136
BURKITT LYMPHOMA .............................................................................................................................. 138
3. PRECURSOR T CELL NEOPLASMS ..................................................................................................... 138
Acute T cell lymphoblastic leukemia or lymphoma (T-ALL) ...................................................... 138
4. PERIPHERAL T CELL AND NK CELL NEOPLASMS ................................................................................... 139
Peripheral T cell lymphoma................................................................................................. 140
Anaplastic Large-Cell lymphoma ......................................................................................... 140
Adult T cell leukemia/lymphoma ......................................................................................... 141
Mycosis Fungoides/Sezary syndrome ................................................................................... 141
Large granular lymphocytic leukemia ................................................................................... 142
Extra-nodal NK/T cell lymphoma ......................................................................................... 142
ENTEROPATHY-ASSOCIATED TCL.............................................................................................................. 142
- Nodular sclerosis ...................................................................................................... 146
- Mixed cellularity ........................................................................................................ 146
- Lymphocyte rich ........................................................................................................ 147
- Lymphocyte depletion ................................................................................................ 147
- Lymphocyte predominant ........................................................................................... 147
Splenic B cell lymphomas .................................................................................................. 148
Hairy-cell leukemia ............................................................................................................ 149
Plasma cell neoplasms ...................................................................................................... 150
SKIN PATHOLOGY ..................................................................................................................... 151
BULLOUS LESIONS OF THE SKIN (NOT ASKED AT THE EXAM) ............................................................................. 154
NON-MELANOCYTIC PIGMENTED SKIN DISORDERS ....................................................................................... 156
3
, EPHELIDS (FRECKLES) ............................................................................................................................ 156
LENTIGO ............................................................................................................................................. 157
MELANOCYTIC LESIONS OF THE SKIN ......................................................................................................... 157
Melanocytic nevi: .............................................................................................................. 157
Dysplastic nevi: ................................................................................................................. 158
Blue nevus ........................................................................................................................ 159
Spitz nevus ....................................................................................................................... 160
Reed nevus ....................................................................................................................... 161
MELANOMA ......................................................................................................................................... 161
Superficial spreading melanoma ......................................................................................... 169
Nodular melanoma ............................................................................................................ 169
Lentigo maligna melanoma ................................................................................................. 169
Acral-Lentiginous Melanoma .............................................................................................. 170
Uveal melanoma ............................................................................................................... 170
Extracutaneous melanoma ................................................................................................. 171
KERATOCYTIC/EPITHELIAL TUMORS ........................................................................................................... 174
Seborrheic keratosis .......................................................................................................... 174
Actinic keratosis ................................................................................................................ 175
Bowen disease .................................................................................................................. 177
Squamous cell carcinoma .................................................................................................. 178
Keratoacanthoma .............................................................................................................. 180
Basal cell carcinoma ......................................................................................................... 180
Merkel cell carcinoma ........................................................................................................ 182
MESENCHYMAL TUMORS ........................................................................................................................ 183
Dermatofibroma (fibrous histiocytoma) ................................................................................ 183
Kaposi Sarcoma ................................................................................................................ 183
ENDOMETRIAL PATHOLOGY ...................................................................................................... 186
CHRONIC ENDOMETRITIS ........................................................................................................................ 186
ENDOMETRIOSIS AND ADENOMYOSIS ........................................................................................................ 186
ENDOMETRIAL POLYPS ........................................................................................................................... 189
Endometrial hyperplasia..................................................................................................... 190
ENDOMETRIAL CARCINOMA ..................................................................................................................... 190
Endometrioid carcinoma .................................................................................................... 191
Serous carcinoma (type 2) .................................................................................................. 192
MALIGNANT MIXED MULLERIAN TUMOR...................................................................................................... 194
ENDOMETRIAL STROMAL TUMORS ............................................................................................................. 195
OVARIAN PATHOLOGY .............................................................................................................. 197
PCOS ................................................................................................................................................ 197
OVARIAN TUMORS ................................................................................................................................. 198
Surface epithelial cell tumors .............................................................................................. 199
GERM CELL TUMORS .............................................................................................................................. 205
Dysgerminoma (not in syllabus) ........................................................................................... 206
Embryonal carcinoma (not in syllabus) ................................................................................. 206
Sex cord-stromal cell tumors .............................................................................................. 208
Metastases to ovaries ........................................................................................................ 209
KRUKENBERG TUMOR............................................................................................................................. 210
INTRAOPERATORY EXAMINATION .............................................................................................. 212
4
