Pathology Puzzles Project gives an opportunity to all the specialists to study interesting morphological cases. It is not only a good educational opportunity but also a chance to discuss the cases within the pathologists’ community. Every month three cases will be uploaded into the Digital Pathology system. Before uploading the cases minimum two specialists will validate them.



A, Uterus, myomectomy: Leiomyoma with infarctive-type necrosis and degenerative changes.

  1. Left ovary, fallopian tube, excision: Serous tumor of low malignant potential (LMP)/Atypically proliferating serous tumor. Hydrosalpinx. Focal endometriotic implant.

All submitted slides were reviewed in conjunction with recut slides (x3) prepared from blocks B4 B9, B10 B11. More

Case 2

2Sections demonstrate a well-circumscribed mass involving the parenchyma of the right lobe of thyroid.

Capsule is thin and intact (no signs of invasion).

The tumor cells are arranged in follicular pattern and possess clear nuclei, some of which contain nuclear grooves and intranuclear pseudoinclusions.

Distribution of vesicular nuclei is uneven, with focal grouping. More

Case 3



This subcutaneous lymph node shows almost complete effacement by the proliferation of two morphologically distinct neoplastic elements; an epithelioid cell and spindle to ovoid cell.

The epithelioid cell is characterized by round to oval or indented nuclei with vesicular chromatin and variable prominent nuclei. The cytoplasm is lightly eosinophilic often with foamy or vacuolated appearance with indistinct cell borders.


Case 4


This skin tumour infiltrate the dermis and efface the subcutaneous fatty tissue and is characterized by atypical cells with eosinophilic cytoplasm, round to oval often with horse-shoe nuclei and frequent multinucleated cells. The chromatin is vesicular and variable prominent nucleoli are seen. The tumour cell dissects the collagen bundles and moderate to abundant lymphoid infiltrate are seen on the background especially around the capillaries. Infrequent mitotic figures are present and proliferation index is around 15%. More

Case 5


Both slides were reviewed and additionally reviewed in staff conference. Recut H&E stains x2 were prepared from both submitted blocks and immunostains for calponin and p63 were prepared from both blocks. Viewers concurred there are foci of DCIS Grade lll involving cores on both slides, with focal central comedo-type necrosis noted. No microinvasion is appreciated, confirmed by retained myoepilnelial cells highlighted by the p63 and calponin immunostains. More